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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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2
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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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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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Staudt MD, MacDougall KW. Spontaneous Regression of an Intraparenchymal Cyst Following Deep Brain Stimulator Electrode Implantation: Case Report and Literature Review. World Neurosurg 2018; 117:249-254. [PMID: 29940379 DOI: 10.1016/j.wneu.2018.06.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The development of an intraparenchymal cyst following deep brain stimulation (DBS) surgery is an uncommon complication that lacks a clearly defined management strategy. The pathophysiology is not known and may be related to perielectrode edema or cerebrospinal fluid tracking. Previous case reports have described various therapies for symptomatic cysts, including hardware removal or conservative treatment with steroids. CASE DESCRIPTION We present a male patient with bilateral DBS of the ventral intermediate nucleus of the thalamus for management of essential tremor, who developed a cystic cavitation at the left electrode tip and was followed without treatment. This patient developed dysarthria, gait impairment, and unilateral motor deficits 3 months after surgery. Perielectrode edema was initially identified, eventually coalescing into a cystic cavitation at the electrode tip. Cystic regression and symptomatic improvement were observed without any surgical or medical intervention, with full cyst resolution by 17 months. CONCLUSIONS Only 15 additional cases have been reported in the literature, although the true incidence may be underreported because of varying practices in obtaining postoperative scans. Cysts were identified in symptomatic patients on average 6.2 months after surgery. All symptomatic cysts were treated with hardware removal or steroid therapy. Observation alone may be sufficient when a DBS-associated cyst is identified. More reports are needed to characterize this rare complication.
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Affiliation(s)
- Michael D Staudt
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada.
| | - Keith W MacDougall
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
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Park HJ, Lee SH, Park HJ, Shin SH. A porencephalic cyst formation in a 6-year-old female with a functioning ventriculoperitoneal shunt: a case-based review. Childs Nerv Syst 2018; 34:611-616. [PMID: 29380111 DOI: 10.1007/s00381-018-3725-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 01/08/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Porencephalic cysts and cerebrospinal fluid (CSF) edema around the intracranial shuntcatheter are rare complications of ventriculoperitoneal shunt (VPS) surgery. Possible mechanisms leading to a porencephalic cyst formation in a patient with a VPS include taut ventricle, dysfunction of distalcatheters, and irreversible damage to the brain parenchyma caused by shunt insertion, chemotherapy, or radiation. Most of the previous reports were due to shunt malfunction and treatment consisted of shunt revision or removal. CASE REPORT We present a case of porencephalic cyst formation in a 6-year-old female as a result ofcerebrospinal fluid under-drainage that was promptly improved with shunt valve adjustment. COCLUSIONS A heightened index of suspicion is required to prevent misdiagnosis of porencephalic cysts astumors or abscesses that may lead to unnecessary surgical explorations. Further research is needed toelucidate the pathophysiological mechanism that causes a porencephalic cyst formation.
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Affiliation(s)
- Hyun Joo Park
- Department of Neurosurgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Lee
- Department of Radiology, National Cancer Center, Goyang, Republic of Korea
| | - Hyeon Jin Park
- Center for Pediatric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Hoon Shin
- Neuro-oncology Clinic, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.
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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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Idiopathic delayed-onset edema surrounding deep brain stimulation leads: Insights from a case series and systematic literature review. Parkinsonism Relat Disord 2016; 32:108-115. [PMID: 27622967 DOI: 10.1016/j.parkreldis.2016.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/12/2016] [Accepted: 09/05/2016] [Indexed: 11/20/2022]
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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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11
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Isolated left homonymous hemianopia secondary to a pericatheter cyst-a rare presentation of a ventriculoperitoneal shunt failure. J Neuroophthalmol 2015; 35:60-4. [PMID: 25426733 DOI: 10.1097/wno.0000000000000189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 26-year-old woman developed a left homonymous hemianopia 1 week after placement of a ventriculoperitoneal shunt through a right parieto-occipital approach. Computed tomography demonstrated a parenchymal cyst in the right occipital lobe. After shunt revision, there was concomitant resolution of the cyst and visual field defect over 1 month. The literature is reviewed regarding this unusual complication of ventriculoperitoneal shunt failure.
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12
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Finet P, Delavallée M, Raftopoulos C. Idiopathic intracranial hypertension following deep brain stimulation for Parkinson's disease. Acta Neurochir (Wien) 2015; 157:443-7. [PMID: 25626428 DOI: 10.1007/s00701-015-2354-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/12/2015] [Indexed: 11/24/2022]
Abstract
Idiopathic intracranial hypertension (IIH) is a syndrome characterized by an increased intracranial pressure of unknown origin arising mainly in overweight females. The typical symptoms of IIH are headaches and papilledema associated with visual disorders, which can often evolve to blindness. We describe the first patient who developed a clinical syndrome related to an IIH following a bilateral subthalamic deep brain stimulation (DBS) procedure for Parkinson's disease with the particularity that the clinical expression of the IIH syndrome was atypical because of the presence of intracerebral electrodes.
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Affiliation(s)
- Patrice Finet
- Department of Neurosurgery, University Hospital St-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
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Ramirez-Zamora A, Levine D, Sommer DB, Dalfino J, Novak P, Pilitsis JG. Intraparenchymal cyst development after deep brain stimulator placement. Stereotact Funct Neurosurg 2013; 91:338-41. [PMID: 23989490 DOI: 10.1159/000350021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 01/20/2013] [Indexed: 11/19/2022]
Abstract
Following deep brain stimulation (DBS) surgery, a variety of potential mechanical or functional complications ranging from perioperative events to hardware malfunction may occur. We present 2 patients who developed a unique complication of cyst formation at the tip of the DBS electrode in the absence of infection. One patient had a unilateral ventral intermediate lead placement for essential tremor, and the other had bilateral subthalamic nucleus (STN) placement for Parkinson's disease. After a period of symptom control, at 3 and 8 months after surgery, respectively, both patients developed new neurological deficits and were found to have a cyst at the left DBS lead tip. The right lead in the patient with the bilateral STN implant was without issue. Both affected leads were removed and the problematic symptoms regressed quickly over several days, though the lesion effect on the patients' initial tremor symptoms lasted for months. Bacteriological cultures of the removed electrodes and wounds were negative. We report a rare complication of DBS and show that simply removing the involved lead results in cyst resolution.
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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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