Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
View/Download PDF

Translate this page into:

Letters to the Editor
10 (
1
); 166-167
doi:
10.4103/jnrp.jnrp_262_18

Commentary

Department of Neurosurgery, Neurosciences Centre, AIIMS, New Delhi, India
Address for correspondence: Dr. Guru Dutta Satyarthee, Room No. 714, Department of Neurosurgery, Neurosciences Centre, AIIMS, New Delhi, India. E-mail: duttaguru2002@yahoo.com

Read COMMENTARY-ARTICLE associated with this -

Licence

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Pseudocyst formation is uncommon but clinically important complication of ventriculoperitoneal (VP) shunt surgery.[12] Its incidence is about 0.7%–4.5%, and characterized by progressive accumulation of cerebrospinal fluid (CSF) around the distal end of the shunt and becomes encased in fibrous tissue surrounded by peritoneum or gut wall and may extend along the shunt track over the anterior abdominal wall, usually causing hindrance of CSF absorption, which being poorly or complete absent, producing local intra-abdominal swelling, and associated with malfunctioning of VP shunt with features of raised intracranial pressure.[234]

Various factors responsible for pseudocyst formation include chronic smoldering abdominal cavity infection, repeated VP shunt revisions, obstruction, or dislodgement of VP shunt catheter.[456] Pathogenesis still remains elusive probably loss of absorptive capacity of CSF within the abdominal cavity may result from subclinical peritonitis causing the formation of multiple adhesions, septation, and band in the abdominal cavity. Yet another important factor is associated higher infection rate of cyst fluid, which is highly variable and ranges from 17% to 80% and commoner isolated pathogenic microorganisms include Staphylococcus epidermidis, Staphylococcus aureus, or Streptococcus.[47]

The spectrum of clinical features includes abdominal pain with possible presence of a palpable mass along with feature of VP shunt malfunction associated with low-grade infection, most frequently occur in the pediatric population. Pediatric patients most often present with neurological sequelae, unlike the adult's counterpart presenting more commonly with abdominal complaints many years after initial VP shunt placement surgery.[356]

The diagnosis is usually done with ultrasound abdomen revealing the presence of localized cyst with embedded distal end of VP shunt catheter. The treatment aim includes surgical drainage of loculated CSF, confirming or ruling out the presence of CSF infection, and appropriate microbial culture sensitivity based antimicrobial therapy and provision of alternative CSF diversion surgery for permitting CSF drainage conduit.[3]

Various surgical options for the treatment of pseudocyst include surgical drainage employing either minimally invasive laparoscopic or exploratory surgical approaches. Diyora et al. managed their cases with exploratory laparotomy and revision VP shunt. Intraoperatively, the distal end of the VP shunt was lying coiled just beneath the abdominal wall in a small cavity, distal slit valve was noted to be blocked and CSF was slowly draining out from proximal slits and patient had a good neurological outcome.[1]

However, controversy exists regarding revision shunt surgery and placement into the abdominal cavity, or ventriculoatrial shunt, or VP shunt. Sharifa observed pseudocyst development is an indication of poor absorbing CSF capacity, and hence, reimplantation of VP shunt distal catheter inside the peritoneal cavity may not be successful and usually associated with repeated postrevision failure.[7] Shah et al. also favored ventriculoatrial or ventriculoplural shunt after culture-based antimicrobial therapy for the appropriate duration or in the absence of infection, the best course of action involves drainage of the pseudocyst followed by the placement of a ventriculoatrial shunt.[8]

REFERENCES

  1. , , , , , . Subcutaneous cerebrospinal fluid pseudocyst: An unusual complication of ventriculoperitoneal shunt. J Neurosci Rural Pract. 2018;10:164-5.
    [Google Scholar]
  2. , , , . Abdominal pseudocyst: Predisposing factors and treatment algorithm. Pediatr Neurosurg. 2005;41:77-83.
    [Google Scholar]
  3. , , , . Cerebrospinal fluid pseudocysts: Sonographic appearance and clinical management. Pediatr Neurosci. 1985;12:80-6.
    [Google Scholar]
  4. , , . Abdominal pseudocysts complicating CSF shunting in infants and children. Report of 18 cases. Pediatr Neurosurg. 1999;31:274-8.
    [Google Scholar]
  5. , , , . Abdominal cerebrospinal fluid pseudocyst mimicking full-term pregnancy. J Surg Case Rep 2012 2012:6.
    [Google Scholar]
  6. , , . Spontaneous concurrent intraspinal and intracranial subdural hematoma: Management and review of literature. J Pediatr Neurosci. 2018;13:24-7.
    [Google Scholar]
  7. , . Ventriculoperitoneal shunt with communicating peritoneal and subcutaneous pseudocysts formation. Int J Health Sci (Qassim). 2014;8:107-11.
    [Google Scholar]
  8. , , , . Abdominal cerebrospinal fluid pseudocysts in children: A complication of ventriculoperitoneal shunt. Indian J Neurosurg. 2015;4:49-51.
    [Google Scholar]

    Fulltext Views
    505

    PDF downloads
    289
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections