Advertisement

Child's Nervous System

, Volume 23, Issue 1, pp 85–90 | Cite as

An alternative approach for management of abdominal cerebrospinal fluid pseudocysts in children

  • Ricardo Santos de Oliveira
  • Aline Barbosa
  • Yvone Avalloni de Moraes Villela de Andrade Vicente
  • Hélio Rubens Machado
Original Paper

Abstract

Background

Cerebrospinal fluid (CSF) abdominal pseudocyst is an uncommon but important complication of ventriculoperitoneal shunts. From the collected series, several features about the etiology and management become apparent. Retrospective data were obtained from 12 children treated with cerebrospinal fluid abdominal pseudocyst defined an alternative approach for management of these patients.

Methods

There were eight girls and four boys who ranged in age from 12 days to 18 years old (mean 7.7 months). The most frequent etiology of the hydrocephalus was Chiari type II malformation in six cases. Initial presentation with shunt malfunction was detected in nine cases. Abdominal distention and/or pain were the most frequent finding in our series (10/12). In only one case, infection was detected for all cerebrospinal fluid abdominal pseudocysts (8.3%). Ventriculoperitoneal shunt (VPS) externalization, antibiotics, and cyst aspiration was performed in 8/12 cases as initial management of abdominal pseudocyst. Ventriculoperitoneal shunt reinsertion in abdominal cavity and/or endoscopic third ventriculostomy (ETV) was performed as final management in 9/12. Ventriculoatrial shunt was used only in three cases. Recurrence of the abdominal cyst was observed in two cases.

Discussion

Based on the success rate (75%) in our series submitted to this management, a ventriculoperitoneal shunt can be safely reinserted in the majority of the patients. Endoscopic third ventriculostomy could be performed in selected cases as an alternative approach. Although infection has been reported as responsible for pseudocyst formation, it was only exceptionally found in our series.

Keywords

Hydrocephalus Cerebrospinal fluid abdominal pseudocyst Ventriculoperitoneal shunt Endoscopic third ventriculostomy 

References

  1. 1.
    Agha FP, Amendola MA, Shirazi KK, Amendola BE, Chandler WF (1983) Abdominal complications of ventriculoperitoneal shunts with emphasis on the role of imaging methods. Surg Gynecol Obstet 156:473–478PubMedGoogle Scholar
  2. 2.
    Burchianti M, Cantini R (1988) Peritoneal cerebrospinal fluid pseudocysts: a complication of ventriculoperitoneal shunts. Childs Nerv Syst 4:286–290PubMedGoogle Scholar
  3. 3.
    Coley BD, Shiels WE II, Elton S, Murakami JW, Hogan MJ (2004) Sonographically guided aspiration of cerebrospinal fluid pseudocysts in children and adolescents. AJR Am J Roentgenol 183:1507–1510PubMedGoogle Scholar
  4. 4.
    Davidson RI (1976) Peritoneal bypass in the treatment of hydrocephalus: historical review and abdominal complications. J Neurol Neurosurg Psychiatry 39:640–646PubMedCrossRefGoogle Scholar
  5. 5.
    Ersahin Y, Mutluer S, Tekeli G (1996) Abdominal cerebrospinal fluid pseudocysts. Childs Nerv Syst 12:755–758PubMedCrossRefGoogle Scholar
  6. 6.
    Esposito C, Porreca A, Gangemi M, Garipoli V, De Pasquale M (1998) The use of laparoscopy in the diagnosis and treatment of abdominal complications of ventriculo–peritoneal shunts in children. Pediatr Surg Int 13:352–354PubMedCrossRefGoogle Scholar
  7. 7.
    Esposito C, Colella G, Settimi A, Centonze A, Signorelli F, Ascione G, Palmieiri A, Gangemi M (2003) One-trocar laparoscopy. A valid procedure to treat abdominal complications in children with peritoneal shunt for hydrocephalus. Surg Endosc 17:828–830PubMedCrossRefGoogle Scholar
  8. 8.
    Fischer EG, Shillito Jr J (1969) Large abdominal cysts: a complication of peritoneal shunts. J Neurosurg 31:441–444PubMedGoogle Scholar
  9. 9.
    Gaskill SJ, Marlin AE (1989) Pseudocysts of the abdomen associated with ventriculoperitoneal shunts: a report of twelve cases and a review of the literature. Pediatr Neurosci 15:23–27PubMedCrossRefGoogle Scholar
  10. 10.
    Goeser CD, McLeary MS, Young LW (1998) Diagnostic imaging of ventriculoperitoneal shunt malfunctions and complications. Radiographics 18:635–651PubMedGoogle Scholar
  11. 11.
    Grosfeld JL, Cooney DR, Smith J, Campbell RL (1974) Intra-abdominal complications following ventriculoperitoneal shunt procedures. Pediatrics 54:791–796PubMedGoogle Scholar
  12. 12.
    Gutierrez FA, Raimondi AJ (1976) Peritoneal cysts: a complication of ventriculoperitoneal shunts. Surgery 79:188–192PubMedGoogle Scholar
  13. 13.
    Harsh III GR (1954) Peritoneal shunt for hydrocephalus: utilizing the fimbria of the fallopian tube for entrance to the peritoneal cavity. J Neurosurg 11:284–294PubMedCrossRefGoogle Scholar
  14. 14.
    Horikawa M, Yamada T, Tominaga K, Yoshida S (1999) Abdominal cerebrospinal fluid pseudocyst in a severely handicapped patient with hydrocephalus. J Child Neurol 14:329–331PubMedGoogle Scholar
  15. 15.
    Lortat-Jacob S, Pierre-Kahn A, Renier D, Hirsch JF, Martelli H, Pellerin D (1984) Complications abdominales des shunts ventriculo-peritoneaux chez l’enfant. Chir Pediatr 25:17–21PubMedGoogle Scholar
  16. 16.
    Mobley III LW, Doran SE, Hellbusch LC (2005) Abdominal pseudocyst: predisposing factors and treatment algorithm. Pediatr Neurosurg 41:77–83PubMedCrossRefGoogle Scholar
  17. 17.
    Parry SW, Schuhmacher JF, Llewellyn RC (1975) Abdominal pseudocysts and ascites formation after ventriculoperitoneal shunt procedures. J Neurosurg 43:476–480PubMedCrossRefGoogle Scholar
  18. 18.
    Pathi R, Sage M, Slavotinek J, Hanieh A (2004) Abdominal cerebrospinal fluid pseudocyst. Australas Radiol 48:61–63PubMedCrossRefGoogle Scholar
  19. 19.
    Rainov N, Schobess A, Heidecke V, Burkert W (1994) Abdominal CSF pseudocysts in patients with ventriculo–peritoneal shunts. Report of fourteen cases and review of the literature. Acta Neurochir 127:73–78CrossRefGoogle Scholar
  20. 20.
    Roitberg BZ, Tomita T, McLone DG (1998) Abdominal cerebrospinal fluid pseudocyst: a complication of ventriculoperitoneal shunt in children. Pediatr Neurosurg 29:267–273PubMedCrossRefGoogle Scholar
  21. 21.
    Rush DS, Walsh JW, Belin RP, Pulito AR (1985) Ventricular sepsis and abdominally related complications in children with cerebrospinal fluid shunts. Surgery 97:420–427PubMedGoogle Scholar
  22. 22.
    Sivalingam S, Corkill G, Getzen L, Matolo N (1976) Recurrent abdominal cyst: a complication of ventriculoperitoneal shunt and its management. J Pediatr Surg 11:1029–1030PubMedCrossRefGoogle Scholar
  23. 23.
    White B, Kropp K, Rayport M (1991) Abdominal cerebrospinal fluid pseudocyst: occurrence after intraperitoneal urological surgery in children with ventriculoperitoneal shunts. J Urol 146:583–587PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Ricardo Santos de Oliveira
    • 1
  • Aline Barbosa
    • 2
  • Yvone Avalloni de Moraes Villela de Andrade Vicente
    • 2
  • Hélio Rubens Machado
    • 1
  1. 1.Division of Pediatric Neurosurgery, Ribeirão Preto School of MedicineUniversity of São PauloSão PauloBrazil
  2. 2.Division of Pediatric Surgery, Ribeirão Preto School of MedicineUniversity of São PauloSão PauloBrazil

Personalised recommendations