Superficial siderosis of the central nervous system after ventriculoperitoneal shunt

Abstract

The authors report a case of superficial siderosis of the CNS that developed after ventriculoperitoneal (VP) shunt placement for normal-pressure hydrocephalus.A 65-year-old woman had undergone VP shunt insertion for normal-pressure hydrocephalus. Her gait disturbance, memory disturbance, and urinary incontinence all improved after the procedure. Two years later, however, her gait became ataxic and her appetite became poor. Brain MR imaging revealed a rim of hypointensity on T2-weighted sequences, enveloping the surface of the cortical fissure, cerebellum, and brainstem. Superficial siderosis of the CNS was diagnosed. Steroid administration improved her symptoms.The authors know of only one case of superficial siderosis developing after VP shunt surgery in the Englishlanguage literature. Superficial siderosis should be acknowledged as a possible complication of VP shunt. (DOI: 10.3171/2009.11.JNS091228) keY worDs • superficial siderosis • ventriculoperitoneal shunt • complication 93Abbreviations used in this paper: NPH = normal-pressure hydrocephalus; VP = ventriculoperitoneal.

Lumbar Subarachnoid-Peritoneal Shunting Deteriorates Superficial Siderosis Associated with a Dural Defect

“…Superficial siderosis is caused by continuous or recurrent bleeding into the subarachnoid space, resulting in the deposition of hemosiderin in the leptomeninges and subpial layers of hindbrain structures, especially the cerebellum, brainstem, and spinal cord [4,5]. Superficial siderosis is characterized by hearing loss (95%), cerebellar ataxia (88%), and pyramidal signs (76%) [3].…”

“…Regarding the relationship between the shunt and superficial siderosis, there are some reports about shuntassociated superficial siderosis [1,4,11]. Kumar et al presented the cases of two patients who developed superficial siderosis after shunt placement, but the clinical details were not described [10].…”

“…Recurrent or continuous bleeding into the cerebrospinal fluid (CSF) has been implicated as a cause of superficial siderosis [2], and is reportedly found in more than half of all cases [3]. Apart from idiopathic superficial siderosis, iatrogenic superficial siderosis has been reported following hemispherectomy, spinal decompression surgery, posterior fossa surgery, and ventriculoperitoneal (V-P) shunt surgery [4].…”

Intracranial dural arteriovenous fistula as a cause for symptomatic superficial siderosis: A report of two cases and review of the literature

“…[ 5 ] SS has been reported in the literature as the result of many vascular and nonvascular intracranial pathologies, including tumors or the brain and spinal cord (e.g., myxopapillary ependymoma), ventricular shunts, chronic subdural hematomas, previous CNS surgery, cavernous, and arteriovenous malformations (AVMs). [ 1 9 17 22 25 27 35 37 39 41 42 ]…”

Complications Associated with Surgical Treatment of Hydrocephalus

“…In addition, epileptic seizure could be a manifestation of shunt malfunction (Johnson et al, 1996). Very rarely, superficial siderosis of the central nervous system (Fig.3) has been reported after VP shunt (Satow et al, 2010). This might be caused by repeated long-lasting contact of the ventricular catheter with the choroid plexus.…”