Efficacy of ventriculoperitoneal shunting in patients with cryptococcal meningitis with intracranial hypertension

Abstract

Background: Ventriculoperitoneal (VP) shunting in cryptococcal meningitis (CM) patients with high intracranial pressure (ICP) has been studied extensively. Methods: A total of 74 CM patients with ICP were identified, including 27 patients with or without ventriculomegaly receiving VP shunting. Results: Through retrospective analysis, there was an obvious decline in ICP as well as Cryptococcus count after VP shunting. Damage to the cranial nerves was improved after the surgery. For those patients receiving VP shunting, there was an obvious decline in ICP as well as Cryptococcus count, with less usage of mannitol. Hydrocephalus or ventriculomegaly was improved, and both the clearance time of Cryptococcus and the hospitalization time were shortened (p < 0.05). The complications of VP shunting were not common. Conclusions: For patients diagnosed with CM and with apparent ICP, VP shunting can be considered regardless of whether there is damage to the cranial nerves or hydrocephaly.

Clinical features and risk factors of surgical site infections in HIV-negative patients with cryptococcal meningitis underwent ventriculoperitoneal shunt operations: a retrospective study

“…VPS, which has been proposed to reduce the development of cerebral hernia, may improve the prognosis of CM patients with intolerable ICH. Most of the patients in this study achieving symptom remission significantly after surgery, the intracranial pressure decreased, the ICH symptoms such as dizziness, headache, nausea and vomiting were remarkably responsive to VPS which in common with the previous study [ 21 ], suggested that VPS surgery would be efficacy to the CM patients complicated with ICH. However, infection would be one of the major complications of VPS surgery.…”

Amphotericin B plus fluorocytosine combined with voriconazole for the treatment of non-HIV and non-transplant-associated cryptococcal meningitis: a retrospective study

“…Elevated intracranial pressure (ICP) is an important factor in morbidity and mortality of CM patients [9,29]. CM patients with persistent high ICP suffer from cranial nerves injury, usually manifested as visual and hearing loss [30]. Therefore, early controlling of ICP is very important for CM patients.…”

Obstructive Hydrocephalus Secondary to Cryptococcal Meningitis in an Immunocompetent Adult

“…The potential risk of seeding cryptococcal infection into the peritoneal cavity has not been definitively proven. The peritoneal cavity is thought to have less favorable conditions for cryptococcal growth, better antifungal penetration through the blood-peritoneum barrier, and more powerful phagocytes [ 11 ]. These factors are thought to greatly reduce the cryptococcal load post-shunting and improve the patient’s clinical condition.…”