Evaluation of ventriculoperitoneal shunt in the treatment of intracranial hypertension in the patients with cryptococcal meningitis: A report of 12 cases

Wang, Hui; Ling, Cong; Chen, Chuan; Huang, He; Luo, Lun; Ning, Xinjie

doi:10.1016/j.clineuro.2014.07.001

Cited by 10 publications

(10 citation statements)

References 13 publications

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“…Contrary to the results of the previous study mentioned previously, 6 sex and cryptococcal antigen levels were not significant factors in predicting the use of shunt treatment (Table 1). These findings may be explained by differences in study populations including ethnicity, total size, and percentage of HIV patients.…”

Section: Discussioncontrasting

confidence: 99%

“…5 A recent study recommended that female patients with elevated cerebrospinal fluid (CSF) cryptococcal antigen undergo continuous CSF drainage. 6 However, the study included only 50 patients, 98% of whom were HIV-positive and the outcome was CSF drainage and not specific to permanent shunting. This research aimed to study the risk factors for permanent shunt treatment becoming necessary in cryptococcal meningitis patients using a larger sample size.…”

Section: Introductionmentioning

confidence: 99%

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Predictive Model for Permanent Shunting in Cryptococcal meningitis

Phusoongnern

Anunnatsiri

Sawanyawisuth

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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Cryptococcal meningitis may have long-term morbidity and requires a permanent cerebrospinal fluid shunt. This study aimed to evaluate the risk factors and create a predictive model for permanent shunt treatment in cryptococcal meningitis patients. This was a retrospective analytical study conducted at Khon Kaen University. The study period was from January 2005 to December 2015. We enrolled all adult patients diagnosed with cryptococcal meningitis. Risk factors predictive for permanent shunting treatment were analyzed by multivariate logistic regression analysis. There were 341 patients diagnosed with cryptococcal meningitis. Of those, 64 patients (18.7%) were treated with permanent shunts. There were three independent factors associated with permanent shunt treatment. The presence of hydrocephalus had the highest adjusted odds ratio at 56.77. The resulting predictive model for permanent shunt treatment (y) is (-3.85) + (4.04 × hydrocephalus) + (2.13 × initial cerebrospinal fluid (CSF) opening pressure (OP) > 25 cm HO) + (1.87 × non-human immune deficiency vrus (HIV)). In conclusion, non-HIV status, initial CSF OP greater than or equal to 25 cm HO, and the presence of hydrocephalus are indicators of the future necessity for permanent shunt therapy.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictive Model for Permanent Shunting in Cryptococcal meningitis

Phusoongnern

Anunnatsiri

Sawanyawisuth

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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“…Persistent and uncorrectable high ICP and associated complications are the primary reasons for failed treatment and a poor prognosis. Therefore, the effective control of high ICP is crucial for a good prognosis (Petrou et al, 2012;Wang et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…In addition to high ICP, CM patients may also show a significant increase in Cryptococcus count in the CSF. Persistent high ICP may be caused by massive proliferation of Cryptococcus in the brain; the large amount of capsular polysaccharides produced blocks the normal circulation of the CSF (Wang et al, 2014;Mohan et al, 2006). Pathogen-directed therapy has proven effective and Figure 2.…”

Section: Discussionmentioning

confidence: 99%

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

Liu

Peng

Weng

et al. 2019

International Journal of Infectious Diseases

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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.

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“…However, relevant articles about VPS treatment in non-HIV patients without ventriculomegaly are limited. Available data are limited to case reports [ 13 ] and smaller case studies [ 22 ]. Comparative data concerning the non-HIV CM population with and without ventriculomegaly are sparse.…”

Section: Discussionmentioning

confidence: 99%

Ventriculoperitoneal shunts in non-HIV cryptococcal meningitis

Liu

Chen

et al. 2018

BMC Neurol

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BackgroundPersistent and uncontrollable intracranial hypertension (ICH) and difficulty in reducing Cryptococcus count are severe problems in cryptococcal meningitis (CM) patients. The therapeutic effects of ventriculoperitoneal shunts (VPS) in non-HIV CM patients are not fully known, and the procedure is somewhat unusual. Here, our study offers a review to investigate the role of VPS in non-HIV CM.MethodsWe retrospectively collected data on 23 non-HIV CM patients with and without ventriculomegaly from 2010 to 2016. Their demographic data, clinical manifestations, cerebrospinal fluid (CSF) features and outcomes were analysed.ResultsWe found that non-HIV CM patients without ventriculomegaly were older, had earlier treatment times and had shorter symptom durations than CM patients with ventriculomegaly. In both groups, headache, vomiting, fever and loss of vision were the most common clinical features. CSF pressure and Cryptococcus count were significantly decreased after operation. VPS could provide sustained relief from ICH symptoms such as headache. 13% of patients had poor outcomes because of serious underlying disease, while 87% of patients had good outcomes.ConclusionsThe use of a VPS is helpful in decreasing ICH and fungal overload in non-HIV CM patients, and VPS should be performed before CM patients present with symptoms of severe neurological deficit.

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Evaluation of ventriculoperitoneal shunt in the treatment of intracranial hypertension in the patients with cryptococcal meningitis: A report of 12 cases

Cited by 10 publications

References 13 publications

Predictive Model for Permanent Shunting in Cryptococcal meningitis

Predictive Model for Permanent Shunting in Cryptococcal meningitis

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

Ventriculoperitoneal shunts in non-HIV cryptococcal meningitis

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