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Smith LE, Zeman BD. Periventricular cyst as a complication of ventriculoperitoneal shunting in the context of intracranial haemorrhage: a case report and review of the literature. J Surg Case Rep 2024; 2024:rjad743. [PMID: 38268536 PMCID: PMC10806387 DOI: 10.1093/jscr/rjad743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024] Open
Abstract
Spontaneous intraventricular haemorrhage with hydrocephalus frequently requires neurosurgical intervention, including ventriculoperitoneal shunting. We describe a periventricular cyst following the placement of a ventriculoperitoneal shunt in a 67-year-old female patient. The patient was admitted for rehabilitation after a spontaneous left basal ganglia and diffuse intraventricular haemorrhage with hydrocephalus. Initial management included an extraventricular drain, followed by a ventriculoperitoneal shunt. On Day 5 of rehabilitation, the patient was urgently reviewed for reduced level of consciousness. A cerebrospinal fluid cyst was identified around the shunt catheter, with subacute haemorrhage within the cyst. The patient underwent a successful shunt revision, with rapid improvement in consciousness and resolution of the cyst. This case highlights the importance of pericatheter cyst as a differential diagnosis in patients with altered neurological status following ventriculoperitoneal shunting. Early detection and surgical revision can lead to rapid resolution of symptoms and a favourable prognosis.
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Affiliation(s)
- Leon E Smith
- Department of Rehabilitation Medicine, Royal North Shore Hospital, Reserve Road St Leonard's 2065, NSW, Australia
| | - Brian D Zeman
- Department of Rehabilitation Medicine, Royal North Shore Hospital, Reserve Road St Leonard's 2065, NSW, Australia
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de Oliveira ST, Cavalcante-Neto JF, Matos LEO, Leal PRL, Ribeiro EML, Cristino-Filho G, da Ponte KF. Intraparenchymal pericatheter cyst as an indicator of ventriculoperitoneal shunt malfunction: A case-based update. Surg Neurol Int 2022; 13:195. [PMID: 35673648 PMCID: PMC9168389 DOI: 10.25259/sni_180_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/14/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Intraparenchymal pericatheter cysts (IPCs) are a rare ventriculoperitoneal shunt (VPS) complication, with only a few cases recorded in the literature. Case Description: We report a 22-year-old woman admitted with headache, papilledema, vision loss, and a history of leukemia. Lumbar puncture revealed idiopathic intracranial hypertension (IIH). Three months after VPS implantation, she was readmitted with headache and worsening of visual impairment. CT evidenced a IPC with perilesional edema. Intraoperatively, a shunt revision and cyst drainage were opted for. We present a discussion and literature review on this unique complication of VPS, with emphasis on management. Conclusion: It is important to understand and consider IPCs as complications of VPS surgery, including in adult patients and IIH cases.
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Shah P, Shetty K, Tang M, Saberi E, Sheikhan N. A Rare Case of Intraparenchymal Cerebrospinal Fluid Cyst Associated With Ventriculoperitoneal Shunt in an Adult Patient. Cureus 2021; 13:e17420. [PMID: 34589330 PMCID: PMC8460290 DOI: 10.7759/cureus.17420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/05/2022] Open
Abstract
Here we are reporting a rare phenomenon associated with ventriculoperitoneal (VP) shunt in the adult patient, namely, the development and finding of intraparenchymal pericatheter cerebrospinal fluid cyst. Our patient had a VP shunt placed for idiopathic intracranial hypertension 16 years ago before presentation to the hospital. The patient was admitted to the hospital for headache for past three weeks with the initial CT scan showing encephalomalacia and vasogenic edema. MRI showed the presence of a 4-cm intraparenchymal cyst in the right frontal lobe with surrounding vasogenic edema. The patient underwent two surgeries with the initial surgery for the drainage of cyst and second surgery for the placement of the cystoperitoneal shunt. Catheter-associated cysts are easily misdiagnosed due to their similarity in appearance to abscesses and other malignancies on imaging, and there are no guidelines yet on their evaluation and management. This is a unique case as the pericatheter cyst developed 16 years after the initial VP shunt placed. Given the rarity of this presentation, we hope that our case report can contribute to the development of guidelines and treatment options in adults with long-standing VP shunts.
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Affiliation(s)
- Pinak Shah
- Internal Medicine, Mountainview Hospital, Las Vegas, USA
| | - Kartika Shetty
- Internal Medicine, Mountainview Hospital, Las Vegas, USA
| | - Maycky Tang
- Internal Medicine, Riverside Community Hospital, Riverside, USA
| | - Elnaz Saberi
- Internal Medicine, Mountainview Hospital, Las Vegas, USA
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Porencephalic cyst after endoscopic third ventriculostomy and Ommaya reservoir placement: case report and review of the literature. Childs Nerv Syst 2021; 37:2917-2921. [PMID: 33442758 DOI: 10.1007/s00381-021-05042-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND A 13-year-old female patient was diagnosed with a tectal glioma (TG), a subgroup of astrocytoma that can result in obstructive hydrocephalus secondary to aqueductal stenosis. Endoscopic third ventriculostomy (ETV) is used to treat this type of hydrocephalus with a good success rate. Our institution performs ETV and Ommaya reservoir (OR) placement in these cases. The OR allows measurement of intracranial pressure (ICP) and cerebrospinal fluid (CSF) access and a method for performing ventricular dye studies to evaluate third ventricular stoma (TVS) patency. In this case, a porencephalic cyst (PC) developed around the OR's ventricular catheter (OVC) two and a half months after surgery. CONCLUSION The PC is thought to have developed in association with TVS stoma closure and resolved after ETV revision.
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Karydakis P, Nikas I, Panagopoulos D, Filippidou M, Sfakianos G, Themistocleous M. Intraparenchymal Pericatheter Cyst after Cerebrospinal Fluid Shunt: A Rare Complication with Challenging Diagnosis - Case Presentation and Review of the Literature. Asian J Neurosurg 2019; 14:581-584. [PMID: 31143289 PMCID: PMC6515991 DOI: 10.4103/ajns.ajns_288_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
An intraparenchymal pericatheter cyst is a rare complication of ventriculoperitoneal shunt, which is not well described yet. Due to its rarity, lack of characteristic symptoms and radiological features that often mimic brain tumors or abscesses, especially in head computed tomography without contrast can be easily misdiagnosed. We report the case of a 9-year-old girl who was admitted to a peripheral hospital due to severe headaches and vomiting. The child had a history of craniotomy and ventriculoperitoneal shunt for posterior fossa tumor, performed in our department, 4 years earlier. The patient underwent a brain magnetic resonance imaging (MRI) scan and transmitted to our hospital with the diagnosis of brain tumor. However, a closer look at the MRI established the diagnosis of intraparenchymal pericatheter cerebrospinal fluid cyst; hence, the patient underwent shunt revision and cyst drainage. We researched the literature and described 20 reported cases, discussing the pathophysiological mechanisms, the radiological features, and the optimal treatment of this interesting, yet a challenging complication.
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Affiliation(s)
| | - Ioannis Nikas
- Department of Medical Imaging and Interventional Radiology, Agia Sofia Children's Hospital, Athens, Greece
| | | | - Maria Filippidou
- First Department of Pediatrics, University of Athens, "Agia Sofia" Children's Hospital, Athens, Greece
| | - George Sfakianos
- Department of Neurosurgery, Children Hospital "Aghia Sophia", Athens, Greece
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Brain Granuloma: Rare Complication of a Retained Catheter. World Neurosurg 2017; 110:210-216. [PMID: 29175575 DOI: 10.1016/j.wneu.2017.11.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ventriculoperitoneal (VP) shunt is the most frequent treatment for hydrocephalus. VP shunt malfunction is a very common problem in neurosurgical practice, often requiring shunt revision procedures. In some cases, complete removal of a VP shunt may present difficulties, leading the surgeon to leave the ventricular catheter in situ. This decision is often made to avoid possible adverse events, primarily risk of life-threatening hemorrhage. However, a nonfunctioning catheter left in the ventricular system may lead to further complications. CASE DESCRIPTION We report the case of an adult man who presented with a tumor-like cystic lesion, with mural and nodular postcontrast enhancement, caused by a huge granuloma formed around the tip of a retained ventricular catheter. CONCLUSIONS This occurrence is extremely rare, and this is the first reported case in the literature. Preoperative differential diagnosis was challenging and included infection, metastasis, dysembryogenetic lesions, and rare reversible porencephalic cysts. According to several physiopathogenetic theories recently reported in the literature, the granuloma may develop as the result of persistent chronic inflammatory reactions between the ventricular catheter left in situ and the brain parenchyma. Application of neuroendoscopic techniques is improving management of VP shunt revisions, allowing safe removal of catheters stuck or lost in the ventricular system. Neuroendoscopy may represent an additional option to avoid possible complications related to retained ventricular catheters.
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Kale HA, Muthukrishnan A, Hegde SV, Agarwal V. Intracranial Perishunt Catheter Fluid Collections with Edema, a Sign of Shunt Malfunction: Correlation of CT/MRI and Nuclear Medicine Findings. AJNR Am J Neuroradiol 2017; 38:1754-1757. [PMID: 28705818 DOI: 10.3174/ajnr.a5291] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/08/2017] [Indexed: 11/07/2022]
Abstract
Fluid collections with edema along the intracranial tract of ventriculoperitoneal shunt catheters in adults are rare and are more frequently seen in children. The imaging appearance of these fluid collections is frequently confusing and presents a diagnostic dilemma. We present 6 cases of adult patients noted to have collections with edema along the tract of ventriculoperitoneal shunt catheters. To our knowledge, there are no previous studies correlating the CT/MR imaging findings with nuclear medicine scans in this entity. We hypothesized that when seen in adults, the imaging findings of a CSF-like fluid collection around the intracranial ventriculoperitoneal shunt catheter on CT/MR imaging may suggest areas of CSF accumulation with interstitial edema. It is important to recognize this rare ventriculoperitoneal shunt complication in adults to prevent misdiagnosis of an abscess or cystic tumor.
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Affiliation(s)
- H A Kale
- From the Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - A Muthukrishnan
- From the Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - S V Hegde
- From the Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - V Agarwal
- From the Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Bianchi F, Frassanito P, Tamburrini G, Caldarelli M, Massimi L. Shunt malfunction mimicking a cystic tumour. Br J Neurosurg 2016; 31:484-486. [PMID: 26853638 DOI: 10.3109/02688697.2016.1140124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Shunt malfunction represents one of the most common problem to deal with in the daily neurosurgical practice. Among the variety of possible presentations, the cyst-like dilatation of the brain around the proximal catheter is one of the most rare and misleading type. The case of a boy with a 'tumour-like' proximal shunt malfunction is described and the pertinent literature is analysed.
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Affiliation(s)
- Federico Bianchi
- a Paediatric Neurosurgery - Department of Neurosurgery , Catholic University Medical School , Rome , Italy
| | - Paolo Frassanito
- a Paediatric Neurosurgery - Department of Neurosurgery , Catholic University Medical School , Rome , Italy
| | - Gianpiero Tamburrini
- a Paediatric Neurosurgery - Department of Neurosurgery , Catholic University Medical School , Rome , Italy
| | - Massimo Caldarelli
- a Paediatric Neurosurgery - Department of Neurosurgery , Catholic University Medical School , Rome , Italy
| | - Luca Massimi
- a Paediatric Neurosurgery - Department of Neurosurgery , Catholic University Medical School , Rome , Italy
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Cerebral parenchymal cyst: A rare complication of ventriculoperitoneal shunt malfunction in an adult. Radiol Case Rep 2015; 8:784. [PMID: 27330614 PMCID: PMC4900199 DOI: 10.2484/rcr.v8i1.784] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We report a rare complication of ventriculoperitoneal (VP) shunt malfunction: an intraparenchymal pericatheter cerebrospinal fluid (CSF) cyst. To the best of our knowledge, this is the second reported case of VP-shunt-related parenchymal CSF cyst to be reported in an adult patient, and the longest reported delay in development of this complication after shunt placement. Mass effect and edema from CSF cysts on CT and even T2 FLAIR sequences suggest the diagnosis of cerebral abscess or tumor. Comprehensive MR imaging can exclude both, and lead to proper management. While this complication is rare, clinicians treating adult patients with shunts, even shunts placed decades prior, need to be aware of it.
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Rim HR, Hwang SK, Kwon SH, Kim HM. Intraparenchymal pericatheter cyst as a complication of a ventriculo-peritoneal shunt in a premature infant. J Korean Neurosurg Soc 2011; 50:143-6. [PMID: 22053237 DOI: 10.3340/jkns.2011.50.2.143] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 12/31/2010] [Accepted: 08/08/2011] [Indexed: 11/27/2022] Open
Abstract
A ventriculo-peritoneal shunt is a standard surgical management for hydrocephalus, but complications may impede the management of this disease. Obstruction of the catheter is one of the most common complications and manifests clinically in various ways. Intraparenchymal cyst development after shunt malfunction has been reported by several authors, but the underlying mechanism and optimal treatment methods are debatable. The authors report a case of intraparenchymal cyst formation around a proximal catheter in a premature infant after a ventriculo-peritoneal shunt and discuss its pathogenesis and management.
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Affiliation(s)
- Hae-Ri Rim
- Department of Pediatrics, Kyungpook National University Hospital, Daegu, Korea
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