Shunt Dependency Syndrome after Cyst-Peritoneal Shunt Resolved by Keyhole Microsurgical Cyst Resection: Two Case Reports and Literature Review

Abstract

Shunt dependency syndrome is a rare but dangerous complication of CP shunt and should be treated in time. Collapsed and thickened cyst wall intermittent covering the catheter head end, decreased brain compliance due to chronic fibrosis, as well as regression of cerebrospinal fluid absorption could be the pathogenesis. We suggest keyhole resection of the residual cyst wall as an effective and mini-invasive treatment option.

Two different indications of ventriculoperitoneal and cystoperitoneal shunting in six dogs

“…However, larger cysts can have a mass effect on neurovascular structures, leading to neurological signs. Major treatment approaches for symptomatic intraarachnoideal cysts (IACs) include microsurgical resection of the AC wall, craniotomy for microsurgical fenestration, combined craniotomy for microsurgical fenestration, and communication between cysts and a ventricle or a neighbouring cistern (cystoventriculostomy or cystocisternostomy), endoscopic fenestration, combined endoscopic fenestration and cystoventriculostomy or cystocisternostomy, cystoperitoneal (CP) shunt, and stereotactic aspiration (Ciricillo et al, 1991;Dewey et al, 2009;Gangemi et al, 2011;Shihab et al, 2011;Kimiwada et al, 2015;Taroni et al, 2015;Platt et al, 2016;Dong et al, 2018;Mustansir et al, 2018). IACs represent 1% of all intracranial masses in humans, and they have been sporadically reported in dogs, where they occur most commonly in the quadrigeminal cistern (Taroni et al, 2015).…”