An alternative approach for management of abdominal cerebrospinal fluid pseudocysts in children

Abstract

Based on the success rate (75%) in our series submitted to this management, a ventriculoperitoneal shunt can be safely reinserted in the majority of the patients. Endoscopic third ventriculostomy could be performed in selected cases as an alternative approach. Although infection has been reported as responsible for pseudocyst formation, it was only exceptionally found in our series.

Ventriculoperitoneal shunt complications needing shunt revision in children: A review of 5 years of experience with 48 revisions

“…Other options are exploratory laparotomy/laparoscopic removal of shunt/ shunt externalization, with or without cyst excision and conversion of VP shunt to VA shunt or third ventriculostomy. [33,[35][36][37] We observed two cases (0.84%) of CSF pseudocysts in peritoneal cavity following VP shunt operations (one for hydrocephalus due to TBM and another for congenital hydrocephalus). Both presented with progressive abdominal distention and malfunction of the peritoneal part of the shunt.…”

“…Ultrasonography and CT scan of the abdomen and pelvis are excellent imaging modalities for diagnosis of CSF pseudocysts. [33][34][35] The treatment options for the CSF pseudocysts peritoneal cavity are excision of the cysts and relocation of the shunt and can be done either through formal laparotomy or laparoscopically. Other options are exploratory laparotomy/laparoscopic removal of shunt/ shunt externalization, with or without cyst excision and conversion of VP shunt to VA shunt or third ventriculostomy.…”

Malignant Cause of Ventriculoperitoneal Shunt ‘Pseudocyst': A Case Report

“…Pseudocyst formation complicates between 0.1 and 10% of VP shunts [3,4,5]. The two most significant risk factors for pseudocyst formation are multiple shunt revisions and infection [6].…”

Cerebrospinal fluid pseudocyst: A rare complication of ventriculo-peritoneal shunting

“…Guided aspiration of cyst content and culture is used to exclude infection 3,4 and proven or suspected infection needs shunt externalization with later repositioning 3 . The shunt may be positioned in a different quadrant of the abdomen or alternatives methods of CSF drainage such as ventriculo-atrial shunts, ventriculo-pleural shunts and endoscopic third ventriculostomy can be utilized 5 . Simply repositioning the shunt tip in the right atrium or the pleural cavity leads to cyst collapse as there is no secretory epithelial lining 4 .…”