Cerebrospinal Fluid Pseudocyst Complicating Ventriculoperitoneal Shunt: Report of Four Cases

Abstract Background Cerebrospinal fluid (CSF) abdominal pseudocyst (APC) is an uncommon complication following ventriculoperitoneal (VP) shunt. Aim To study the clinical features and management of this entity. The authors present their experience with cases of CSF pseudocyst in children. Materials and Methods Retrospective analysis of four cases diagnosed to have APC following VP shunt between 2005 and 2015. Results Clinical presentation was with progressive abdominal distension, highlights of intestinal obstruction, and signs of raised intracranial pressure (ICP). Diagnosis is readily made with ultrasonography and computed tomographic (CT) scan of the abdomen. The duration between insertion of the shunt and the presentation ranged from 4.11 to 12 years. In three patients, the cyst was unilocular and of varying size. The fourth one had a multilocular cyst. In three patients, the treatment involved was surgical removal of the catheter with excision of the pseudocyst wall and placement of a new catheter intraperitoneally in a different quadrant. Ultrasound-guided aspiration of the cyst and relocation of the distal end was done in one patient. Conclusion Initial suspicion with appropriate investigation and early treatment can avert morbidity and mortality.

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Abdominal Cerebrospinal Fluid Pseudocyst Diagnosed with Point-of-care Ultrasound

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2018.11.40780 ◽

2019 ◽

Vol 3 (1) ◽

pp. 43-46 ◽

Cited By ~ 1

Author(s):

Brittany Guest ◽

Michael Merjanian ◽

Emily Chiu ◽

Caleb Canders

Keyword(s):

Computed Tomography ◽

Cerebrospinal Fluid ◽

Point Of Care ◽

Secondary Infection ◽

Abdominal Cavity ◽

Abdominal Distension ◽

Point Of Care Ultrasound ◽

Vp Shunt ◽

Abdominal Complications ◽

Abdominal Pseudocyst

Abdominal pseudocysts are rare complications of ventriculoperitoneal (VP) shunts characterized by accumulations of cerebrospinal fluid surrounded by fibrous layers in the intra-abdominal cavity or abdominal wall. We present a woman with bilateral VP shunts who presented with right-sided abdominal distension, pain, and tenderness and who was found to have an abdominal pseudocyst on point-of-care ultrasound and computed tomography. Given the potential to develop a secondary infection or VP shunt malfunction, it is important for emergency providers to consider intra-abdominal complications of VP shunts, including rare ones such as abdominal pseudocysts, in these patients who present with vague abdominal complaints.

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BILATERAL OSTEOMAS ARISING FROM THE INTERNAL AUDITORY CANAL

Neurosurgery ◽

10.1227/01.neu.0000316023.81786.b6 ◽

2008 ◽

Vol 62 (2) ◽

pp. E528-E529 ◽

Cited By ~ 15

Author(s):

Venelin M. Gerganov ◽

Amir Samii ◽

Vincenzo Paterno ◽

Alexandru C. Stan ◽

Madjid Samii

Keyword(s):

Cerebellopontine Angle ◽

Management Strategy ◽

Clinical Presentation ◽

Internal Auditory Canal ◽

Brain Magnetic Resonance Imaging ◽

Surgical Removal ◽

Vestibulocochlear Nerve ◽

Computed Tomographic ◽

First Case ◽

Symptomatic Side

Abstract OBJECTIVE Osteomas arising from the internal auditory canal and developing in the cerebellopontine angle have rarely been reported. We present the first case of bilateral osteomas in this region and describe our management strategy. CLINICAL PRESENTATION A 30-year-old woman presented with strong vertigo, tinnitus, and hypacusis on the left side. Brain magnetic resonance imaging and computed tomographic scans displayed bilateral cerebellopontine angle osteomas arising from the internal auditory canal. The larger tumor on the left side was found to be compressing the vestibulocochlear nerve. INTERVENTION Surgery was performed on the symptomatic side via the retrosigmoid approach, and the tumor was removed completely. The vertigo resolved completely after surgery, and the patient had no further tinnitus attacks. An audiogram showed slightly improved hearing with a mean of 20 dB in the main speech area. CONCLUSION Osteomas should be considered in patients with bilateral cerebellopontine angle tumors. Surgical removal might provide resolution of symptoms.

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An Intra-Abdominal Pseudocyst around a Ventriculoperitoneal Shunt due toStreptococcusInfection 7 Years after Shunt Surgery

Surgery Research and Practice ◽

10.1155/2014/898510 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Arata Tomiyama ◽

Jun-ichi Harashina ◽

Hitoshi Kimura ◽

Keisuke Ito ◽

Yoshihiko Honda ◽

...

Keyword(s):

Obstructive Hydrocephalus ◽

Abdominal Mass ◽

Abdominal Cavity ◽

Chronic Phase ◽

Abdominal Distension ◽

Shunt Surgery ◽

Postoperative Course ◽

Vp Shunt ◽

Shunt Tube ◽

Abdominal Pseudocyst

In 1999, a 50-year-old woman underwent ventriculoperitoneal (VP) shunt surgery for hydrocephalus after subarachnoid hemorrhage. She was hospitalized for fever and recurrent systemic seizures in November 2006. Head computed tomography (CT) showed only old changes. The seizures and fever were controlled by medicinal therapy. However, in December, her consciousness level suddenly decreased, and she showed progressive lower abdominal distension. Head CT showed marked ventriculomegaly, and abdominal CT showed a giant cystic mass at the shunt-tube tip in the lower abdominal cavity. Because thick pus was aspirated from the intra-abdominal mass, we diagnosed the patient with acute obstructive hydrocephalus due to an infected abdominal pseudocyst. Laparotomy and direct cyst drainage were performed, and antibiotic therapy againstStreptococcus,the causative pathogen, was administered. The VP shunt tube was replaced. The postoperative course was uneventful, and postoperative CT showed hydrocephalus improvement and no pseudocyst recurrence. Abdominal pseudocysts, which are rare after VP shunt surgeries, usually occur after the subacute postoperative course in younger cerebral hemorrhagic cases. Our case was quite rare because the cyst developed in the chronic phase in an older patient and was caused by streptococcal infection. The cyst components should be examined before cyst drainage when choosing surgical strategies.

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Largest Abdominal CSF Pseudocyst – An Uncommon Complication of VP Shunt

Nepalese Journal of Radiology ◽

10.3126/njr.v3i1.8820 ◽

2013 ◽

Vol 3 (1) ◽

pp. 89-90

Author(s):

Hiteshkumar D Lukhi ◽

M Singh ◽

S Chakravarthy ◽

N Perwez

Keyword(s):

Cerebrospinal Fluid ◽

Liver Disease ◽

Alcoholic Liver Disease ◽

Early Treatment ◽

Morbidity And Mortality ◽

Provisional Diagnosis ◽

Vp Shunt ◽

Important Complication ◽

Pseudocyst Formation ◽

Uncommon Complication

Abdominal cerebrospinal fluid (CSF) pseudocyst is an unusual and important complication in patients with ventriculoperitoneal (VP) shunt. A 36yrs old male referred to the Department of Radiology for USG abdomen with complaints of gradually increasing distension of abdomen and provisional diagnosis of Alcoholic liver disease. Successive radiological investigations lead to diagnosis of malfunctioning VP shunt, secondary to abdominal CSF pseudocyst formation. Due to lack of suspiciousness patient had developed a giant abdominal CSF pseudocyst, size of which has not been reported in any literature so far. Hence, initial suspicion with appropriate investigation and early treatment can prevent morbidity and mortality. Nepalese Journal of Radiology / Vol.3 / No.1 / Issue 4 / Jan-June, 2013 / 89-90 DOI: http://dx.doi.org/10.3126/njr.v3i1.8820

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When less is more: a daring conservative approach to postpneumonectomy oesophago-pleural fistula

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz240 ◽

2019 ◽

Vol 30 (1) ◽

pp. 146-148

Author(s):

Lara Girelli ◽

Elena Prisciandaro ◽

Niccolò Filippi ◽

Lorenzo Spaggiari

Keyword(s):

Clinical Presentation ◽

Clinical Status ◽

High Morbidity ◽

Conservative Approach ◽

Chronic Fistula ◽

Less Is More ◽

Primary Surgery ◽

History Of ◽

Uncommon Complication

Abstract Oesophago-pleural fistula is an uncommon complication after pneumonectomy, usually related to high morbidity and mortality. Due to its rarity and heterogeneous clinical presentation, its diagnosis and management are challenging issues. Here, we report the case of a patient with a history of pneumonectomy for a tracheal tumour, who developed an asymptomatic oesophago-pleural fistula 7 years after primary surgery. In consideration of the patient’s good clinical status and after verifying the preservation of respiratory and digestive functions, a bold conservative approach was adopted. Five-year follow-up computed tomography did not disclose any sign of recurrence of disease and showed a stable, chronic fistula.

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Overshunting-Related Cervical Myelopathy Causing Progressive Gait Disturbance: A Case Report

Case Reports in Neurology ◽

10.1159/000514551 ◽

2021 ◽

pp. 312-317

Author(s):

Eva Vister ◽

Sebastiaan Hammer ◽

Rudolf W.M. Keunen ◽

Astrid L. Rijssenbeek ◽

Niels A. van der Gaag

Keyword(s):

Cerebrospinal Fluid ◽

Cervical Myelopathy ◽

Complete Resolution ◽

Late Complication ◽

Gait Disturbance ◽

Shunt Revision ◽

Proper Treatment ◽

Cervical Stenosis ◽

Vp Shunt ◽

Associated Symptoms

A complication of ventriculoperitoneal (VP) shunting is overdrainage or overshunting of cerebrospinal fluid, which can cause formation of hygroma but in rare cases also cervical myelopathy at a later stage. In this article, we describe a very late complication of VP shunting. We present a 75-year-old man, previously given a VP shunt at the age of 46, who developed a progressive gait disturbance and ataxia of the limbs after 27 years. MRI showed a cervical stenosis and myelopathy as a result of venous engorgement due to chronic overshunting of the VP shunt. Revision of the VP shunt resulted in complete resolution of his neurological symptoms and the cervical myelopathy. Cervical myelopathy due to chronic overshunting is a rare and potentially very late complication of a VP shunt. Our case underlines the importance of awareness of this complication while proper treatment can reverse the associated symptoms fully.

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Hemorrhagic abdominal pseudocyst following ventriculoperitoneal shunt: a case report

BMC Surgery ◽

10.1186/s12893-021-01161-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hong-Cai Wang ◽

Yi-Lei Tong ◽

Shi-Wei Li ◽

Mao-Song Chen ◽

Bo-Ding Wang ◽

...

Keyword(s):

Fibrous Tissue ◽

Clinical Signs ◽

Chronic Subdural Hematoma ◽

Normal Pressure ◽

Cystic Mass ◽

Shunt Revision ◽

Subdural Effusion ◽

Palpable Mass ◽

Vp Shunt ◽

Abdominal Pseudocyst

Abstract Background Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported many cases of abdominal CSF pseudocyst following VP shunts, no case of a hemorrhagic abdominal pseudocyst after VP shunts has been reported so far. Case presentation This article reports a 68-year-old woman with a 4-month history of progressive abdominal pain and distention. She denied any additional symptoms. A VP shunt was performed 15 years earlier to treat idiopathic normal pressure hydrocephalus and no other abdominal surgery was performed. Physical examination revealed an elastic palpable mass in her right lower abdomen, which was dull to percussion. Abdominal computed tomography (CT) scan indicated a large cystic collection of homogenous iso-density fluid in the right lower abdominal region with clear margins. The distal segment of the peritoneal shunt catheter was located within the cystic mass. Abdominal CSF pseudocyst was highly suspected as a diagnosis. Laparoscopic cyst drainage with removal of the whole cystic mass was performed, 15-cm cyst which found with thick walls and organized chronic hematic content. No responsible vessel for the cyst hemorrhage was identified. No further shunt revision was placed. Histological examination showed that the cyst wall consisted of outer fibrous tissue and inner granulation tissue without epithelial lining, and the cystic content was chronic hematoma. The patient had an uneventful postoperative course and remained asymptomatic for 8-mo follow-up. Conclusion To the best of our knowledge, this is the first report of hemorrhagic onset in the abdominal pseudocyst following VP shunt. Such special condition can accelerate the appearance of clinical signs of the abdominal pseudocyst after VP shunts, and its mechanisms may be similar to the evolution of subdural effusion into chronic subdural hematoma (CSDH).

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Unusual Transoral Penetrating Injury of the Foramen Magnum: Case Report

Neurosurgery ◽

10.1227/01.neu.0000084081.61681.8b ◽

2003 ◽

Vol 53 (4) ◽

pp. 989-991 ◽

Cited By ~ 5

Author(s):

Bradley J. Bartholomew ◽

Charla Poole ◽

Emilio C. Tayag

Keyword(s):

Cerebrospinal Fluid ◽

Unusual Case ◽

Spinal Injury ◽

Foramen Magnum ◽

Penetrating Injuries ◽

Computed Tomographic ◽

Foreign Objects ◽

Computed Tomographic Scan ◽

Posterior Pharynx ◽

The Right

Abstract OBJECTIVE AND IMPORTANCE Penetrating injuries of the cranium and spine are frequent to the civilian neurosurgical practice. Although a variety of unusual objects have been reported, to our knowledge, there has never been a craniocerebral or spinal injury caused by a fish. An unusual case of transoral penetration of the foramen magnum by a billed fish is described. The history, radiographic studies, and treatment are presented. CLINICAL PRESENTATION A fisherman struck by a jumping fish initially presented with severe neck pain and stiffness, bleeding from the mouth, and a laceration in the right posterior pharynx. A computed tomographic scan of the cervical spine revealed a wedge-shaped, hyperdense object extending from the posterior pharynx into the spinal canal between the atlas and the occiput. Because of the time factor involved, the fisherman was brought directly to surgery for transoral removal of the object. INTERVENTION The patient was placed under general anesthesia, and with a tonsillar retractor, a kipner, and hand-held retractors, the object was visualized and identified as a fish bill. Further dissection above the anterior aspect of the atlas permitted removal of the object by means of a grabber from an arthroscopic set. No expression of cerebrospinal fluid was noted, and a Penrose drain was placed. CONCLUSION The patient was treated under the assumption that penetrating foreign objects in continuity with the cerebrospinal fluid space and the outside environment should be removed as soon as possible. The patient was provided appropriate antibiotics to treat potential infection of normal pharyngeal flora and organisms unique to the marine environment. The patient recovered and did not experience any residual neurological deficit.

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Surgical removal of bilateral papillomas of the choroid plexus of the lateral ventricles with resolution of hydrocephalus

Journal of Neurosurgery ◽

10.3171/jns.1979.50.5.0677 ◽

1979 ◽

Vol 50 (5) ◽

pp. 677-681 ◽

Cited By ~ 38

Author(s):

Steven K. Gudeman ◽

Humbert G. Sullivan ◽

Michael J. Rosner ◽

Donald P. Becker

Keyword(s):

Cerebrospinal Fluid ◽

Choroid Plexus ◽

Large Volume ◽

Surgical Removal ◽

Tumor Removal ◽

Content Type ◽

Lateral Ventricles ◽

Csf Diversion ◽

Csf Production ◽

Fine Print

✓ The authors report a patient with bilateral papillomas of the choroid plexus of the lateral ventricles with documentation of cerebrospinal fluid (CSF) hypersecretion causing hydrocephalus. Special attention is given to the large volume of CSF produced by these tumors (removal of one tumor reduced CSF outflow by one-half) and to the fact that CSF diversion was not required after both tumors were removed. Since tumor removal alone was sufficient to stop the progression of hydrocephalus, we feel that this case supports the concept that elevated CSF production by itself is sufficient to cause hydrocephalus in patients with papillomas of the choroid plexus.

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