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Child's Nervous System

, 25:1061 | Cite as

CSF overdrainage in shunted intracranial arachnoid cysts: a series and review

  • Juan F. Martínez-LageEmail author
  • Antonio M. Ruíz-Espejo
  • María-José Almagro
  • Raúl Alfaro
  • Matías Felipe-Murcia
  • A. López López-Guerrero
Original Paper

Abstract

Background

Cerebrospinal fluid (CSF) overdrainage in hydrocephalus is well recognized. Overshunting following cysto-peritoneal (CP) drainage in patients with arachnoid cysts (AC) is rarely documented.

Aim

We report five patients with acquired Chiari malformation I and three with posterior fossa overcrowding due to excessive CSF drainage in shunted intracranial ACs. We review our observations and discuss the current knowledge on the pathogenesis and management of this complication.

Patients and methods

The medical records of the eight patients were analyzed in regard to clinical manifestation, cyst and shunt characteristics, management, and outcomes.

Results

Mean age of the patients was 5.5 years. After an average interval of 5 years, five patients developed symptoms related to hindbrain herniation and three to severe shunt overdrainage following CP shunting. Several management modalities were utilized that achieved a good result in seven instances.

Discussion

Some shunted ACs may evolve with overdrainage syndromes. Posterior fossa overcrowding and tonsillar herniation constitute their most severe forms. CSF hypotension, bone changes, venous engorgement, and probably cerebral chronic edema at the posterior fossa constitute the main factors involved in the pathogenesis of this entity. We also review previous instances of acquired Chiari malformation originating after AC shunting.

Conclusions

Posterior fossa overcrowding and acquired Chiari I malformation can develop after excessive CSF drainage of intracranial ACs. Overshunting manifestations require prompt recognition and management. Preventive measures consist of making a stringent selection of cases being considered for surgery, avoiding CP drainage, and placing of a programmable valve as initial treatment of intracranial ACs if shunting is considered.

Keywords

Arachnoid cysts Arachnoid cyst overdrainage syndromes Acquired Chiari type I malformation CSF hypotension CSF overdrainage syndromes Cysto-peritoneal shunting Programmable valves Slit ventricle syndrome 

References

  1. 1.
    Aoki N, Sakai T, Umezawa Y (1990) Slit ventricle syndrome after cyst-peritoneal shunting for the treatment of intracranial arachnoid cyst. Childs Nerv Syst 6:41–43PubMedCrossRefGoogle Scholar
  2. 2.
    Caldarelli M, Novegno F, Di Rocco C (2009) A late complication of CSF shunting: acquired Chiari I malformation. Childs Nerv Syst 25:443–452PubMedCrossRefGoogle Scholar
  3. 3.
    Di Rocco C, Tamburrini G (2003) Shunt dependency in shunted arachnoid cyst: a reason to avoid shunting (letter). Pediatr Neurosurg 38:164PubMedCrossRefGoogle Scholar
  4. 4.
    Di Rocco C, Velardi F (2003) Acquired Chiari type I malformation managed by supratentorial cranial enlargement. Childs Nerv Syst 19:800–807PubMedCrossRefGoogle Scholar
  5. 5.
    Di Rocco C, Tamburrini G, Caldarelli M, Velardi F, Santini P (2003) Prolonged ICP monitoring in Sylvian arachnoid cysts. Surg Neurol 60:211–218PubMedCrossRefGoogle Scholar
  6. 6.
    Fagan LH, Ferguson S, Yassari R, Frimm DM (2006) The Chiari pseudotumor syndrome: symptoms recurrence after decompressive surgery for Chiari malformation type I. Pediatr Neurosurg 42:14–19PubMedCrossRefGoogle Scholar
  7. 7.
    Hamid NA, Sgouros S (2005) The use of an adjustable valve to treat over-drainage of a cyst-peritoneal shunt in a child with a large sylvian fissure arachnoid cyst. Childs Nerv Syst 21:991–994PubMedCrossRefGoogle Scholar
  8. 8.
    Hassounah MI, Rahm BE (1994) Hindbrain herniation: an unusual occurrence after shunting of intracranial arachnoid cyst. J Neurosurg 81:126–129PubMedCrossRefGoogle Scholar
  9. 9.
    Khorasani L, Sikorski CW, Frimm DM (2004) Lumbar CSF shunting preferentially drains the cerebral subarachnoid over the ventricular spaces: implications for the treatment of slit ventricles syndrome. Pediatr Neurosurg 2004:270–276CrossRefGoogle Scholar
  10. 10.
    Kim SK, Cho BK, Chung YN, Kim HS, Wang KC (2002) Shunt dependency in shunted arachnoid cysts: a reason to avoid shunting. Pediatr Neurosurg 2002:178–185CrossRefGoogle Scholar
  11. 11.
    Lazareff JA, Kelly J, Saito M (1998) Herniation of cerebellar tonsils following supratentorial shunt placement. Childs Nerv Syst 14:394–397PubMedCrossRefGoogle Scholar
  12. 12.
    Le H, Yamini B, Frimm DM (2002) Lumboperitoneal shunting as a treatment for slit ventricle syndrome. Pediatr Neurosurg 36:178–182PubMedCrossRefGoogle Scholar
  13. 13.
    Maixner VJ, Besser M, Johnston IH (1992) Pseudotumor syndrome in treated arachnoid cysts. Childs Nerv Syst 8:207–210PubMedCrossRefGoogle Scholar
  14. 14.
    Martínez-Lage JF, Alamo L, Poza M (1999) Raised intracranial pressure in minimal forms of craniosynostosis. Childs Nerv Syst 15:11–16PubMedCrossRefGoogle Scholar
  15. 15.
    Martínez-Lage JF, Pérez-Espejo MA, Almagro MJ, Ros de San Pedro J, López F, Piqueras C, Tortosa J (2005) Syndromes of overdrainage of ventricular shunting in childhood hydrocephalus. Neurocirugía (Astur) 16:124–133 (in Spanish)Google Scholar
  16. 16.
    Martínez-Lage JF, Valentí JA, Piqueras C, Ruíz-Espejo AM, Román F, Nuño de la Rosa JA (2006) Functional assessment of intracranial arachnoid cysts with TC99 m-HMPAO SPECT: a preliminary report. Childs Nerv Syst 22:1091–1097PubMedCrossRefGoogle Scholar
  17. 17.
    Martínez-Lage JF, Ruíz-Espejo Vilar A, Pérez-Espejo MA, Almagro MJ, Ros de San Pedro J, Felipe Murcia M (2006) Shunt-related craniocerebral disproportion: treatment with cranial vault expanding procedures. Neurosurg Rev 29:229–235PubMedCrossRefGoogle Scholar
  18. 18.
    Mendonça R, Fortes Lima TT, Oppitz PP, Raupp SF (2006) Herniation of the cerebellar tonsils after suprasellar arachnoid cyst shunt. Arq Neuropsiquiatr 64:523–525PubMedGoogle Scholar
  19. 19.
    Naidich TP, Radkowski MA, McLone DG, Leetsma J (1996) Chronic cerebral herniation in shunted Dandy-Walker malformation. Radiology 158:431–434Google Scholar
  20. 20.
    Rekate HL (1993) Classification of slit-ventricle syndromes using intracranial pressure monitoring. Pediatr Neurosurg 19:15–20PubMedCrossRefGoogle Scholar
  21. 21.
    Rekate HL (2007) Hydrocephalus and idiopathic intracranial hypertension (editorial). J Neurosurg Pediatr 107(6 Suppl):435–438CrossRefGoogle Scholar
  22. 22.
    Sunami K, Saeki N, Sunada S, Hoshi S, Murai H, Kubota M et al (2002) Slit ventricle syndrome after cyst-peritoneal shunting for temporal arachnoid cyst in children—a clinical entity difficult to detect on neuroimaging study. Brain Dev 24:776–779PubMedCrossRefGoogle Scholar
  23. 23.
    Weaver KD, Ewend MG (2000) Development of an arachnoid cyst after ventriculoperitoneal shunt placement. Case illustration. J Neurosurg 92:363PubMedCrossRefGoogle Scholar
  24. 24.
    Yoshioka S, Matsukado Y, Naghiro S, Moroki K (1987) Shunt-dependent CSF absorption after cysto-peritoneal shunt in patients with arachnoid cysts. Shoni No Noshinkei 12:429–436 (in Japanese)Google Scholar
  25. 25.
    Zada G, Krieger MD, McNatt SA, Bowen I, McComb G (2007) Pathogenesis and treatment of intracranial arachnoid cysts in pediatric patients younger than 2 years of age. Neurosurg Focus 22(2):E1–E5PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Juan F. Martínez-Lage
    • 1
    Email author
  • Antonio M. Ruíz-Espejo
    • 1
  • María-José Almagro
    • 1
  • Raúl Alfaro
    • 1
  • Matías Felipe-Murcia
    • 1
  • A. López López-Guerrero
    • 1
  1. 1.Regional Service of NeurosurgeryVirgen de la Arrixaca University Hospital, Murcia’s Service of HealthMurciaSpain

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