Abdominal Cerebrospinal Fluid Pseudocysts associated with Ventriculo-peritoneal Shunt in Children : Report of Twelve Cases and Review of the Literature

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  • 小児の髄液短絡術に伴う腹腔内髄液仮性嚢胞 : 12症例における検討

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Abstract

Peritoneal shunt is a common surgical procedure for hydrocephalus, and shunt revisions to deal with malfunction and/or complications are frequent. However, an abdominal cerebrospinal fluid pseudocyst is an infrequent complication of ventriculo-peritoneal shunt in children's peritoneal shunt procedures. We report here 12 cases of abdominal pseudocysts and examine their etiology diagnosis, clinical signs and symptoms and surgical management. In our hydrocephalus series, we found that the incidence of pseudocyst formation was 4.2%. The common presentation of those cases were abdominal signs such as vomiting, pain, distention in 11 cases, rather than neurological signs. In five of the children, symptoms or signs of increased intracranial pressure also appeared. Eight patients had a history of shunt revision. The diagnosis was based on findings obtained with abdominal computed tomography, where necessary, ultrasonography and shuntography. But in many cases, the latter two procedures were sufficient. Treatment of the cyst consisted of repositioning of the shunt tube (6 cases), of removal of the shunt tube and extraventricle drainage (5 cases), and of puncture of the cyst (1 case). Repositioning of the shunt tube in the abdominal cavity was not sufficient for the treatment. The patients who underwent extraventricle drainage of the shunt tube showed only one recurrence. Regardless of infection, removal of the shunt tube and extraventricle drainage of the shunt tube is thus considered to be the most reliable treatment of this complication.

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