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Jaganathan S, Baker A, Ram A, Krishnan V, Elhusseiny AM, Philips PH, Glasier CM, Jayappa S, Choudhary A, Ramakrishnaiah R. Collapse or distention of the perioptic space in children - What does it mean to pediatric radiologists? Comprehensive review of perioptic space evaluation. Clin Imaging 2024; 111:110150. [PMID: 38723403 DOI: 10.1016/j.clinimag.2024.110150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 06/01/2024]
Abstract
The perioptic space comprises the subarachnoid space [SAS] of the optic nerve communicating with the SAS of the central nervous system. Pressure variations in the SAS of the central nervous system can be transmitted to the optic papilla through the perioptic space. Variations in the diameter of the perioptic space serve as an important indicator for select intracranial pathologies in the pediatric population. Though the perioptic space can be evaluated using various imaging modalities, MRI is considered highly effective due to its superior soft tissue resolution. With advancement in MR imaging techniques, high-resolution images of the orbits can provide improved visualization of the perioptic space. It is imperative for the pediatric radiologist to routinely assess the perioptic space on brain and orbit MR imaging, as it can prompt exploration for additional features associated with select intracranial pathologies, thus improving diagnostic accuracy. This article reviews basic anatomy of the perioptic space, current understanding of the CSF dynamics between the perioptic space and central nervous system SAS, various imaging modalities utilized in the assessment of the perioptic space, MRI sequences and the optimal parameters of specific sequences, normal appearance of the perioptic space on MR imaging, and various common pediatric pathologies which cause alteration in the perioptic space.
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Affiliation(s)
- Sriram Jaganathan
- Department of Pediatric Radiology, Arkansas Children Hospital, University of Arkansas for Medical Sciences, 1, Children's Way, Little Rock, AR 72202, USA.
| | - Andrew Baker
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | | | - Venkatram Krishnan
- Department of Pediatric Radiology, Arkansas Children Hospital, University of Arkansas for Medical Sciences, 1, Children's Way, Little Rock, AR 72202, USA
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul H Philips
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Charles M Glasier
- Department of Pediatric Radiology, Arkansas Children Hospital, University of Arkansas for Medical Sciences, 1, Children's Way, Little Rock, AR 72202, USA
| | - Sateesh Jayappa
- Department of Pediatric Radiology, Arkansas Children Hospital, University of Arkansas for Medical Sciences, 1, Children's Way, Little Rock, AR 72202, USA
| | - Arabinda Choudhary
- Department of Pediatric Radiology, Arkansas Children Hospital, University of Arkansas for Medical Sciences, 1, Children's Way, Little Rock, AR 72202, USA
| | - Raghu Ramakrishnaiah
- Department of Pediatric Radiology, Arkansas Children Hospital, University of Arkansas for Medical Sciences, 1, Children's Way, Little Rock, AR 72202, USA
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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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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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Porencephalic cyst after endoscopic third ventriculostomy and Ommaya reservoir placement: case report and review of the literature. Childs Nerv Syst 2021; 37:2917-2921. [PMID: 33442758 DOI: 10.1007/s00381-021-05042-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND A 13-year-old female patient was diagnosed with a tectal glioma (TG), a subgroup of astrocytoma that can result in obstructive hydrocephalus secondary to aqueductal stenosis. Endoscopic third ventriculostomy (ETV) is used to treat this type of hydrocephalus with a good success rate. Our institution performs ETV and Ommaya reservoir (OR) placement in these cases. The OR allows measurement of intracranial pressure (ICP) and cerebrospinal fluid (CSF) access and a method for performing ventricular dye studies to evaluate third ventricular stoma (TVS) patency. In this case, a porencephalic cyst (PC) developed around the OR's ventricular catheter (OVC) two and a half months after surgery. CONCLUSION The PC is thought to have developed in association with TVS stoma closure and resolved after ETV revision.
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Management of Hydrocephalus in Children: Anatomic Imaging Appearances of CSF Shunts and Their Complications. AJR Am J Roentgenol 2020; 216:187-199. [PMID: 33112667 DOI: 10.2214/ajr.20.22888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. This article addresses the management of hydrocephalus and the CSF shunts used to treat this entity. CONCLUSION. CSF shunts have a high failure rate. Imaging plays a pivotal role in assessing CSF shunt failure and determining the need for surgical revision. An in-depth knowledge of CSF shunt components, their failure modes, and the corresponding findings on anatomic imaging studies is necessary to ensure timely diagnosis and prevent permanent neurologic damage.
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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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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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Champagne PO, Decarie JC, Crevier L, Weil AG. Dissecting spontaneous cerebrospinal fluid collection. Med Hypotheses 2018. [PMID: 29523303 DOI: 10.1016/j.mehy.2018.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hydrocephalus is a common condition in the pediatric population known to have many causes and presentation patterns. We report from the analysis of 2 cases the existence of a new complication of pediatric hydrocephalus. Naming this entity "dissecting intraparenchymal cerebrospinal fluid collection", we advance a hypothesis regarding its pathophysiology and discuss its clinical implications and management.
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Affiliation(s)
- Pierre-Olivier Champagne
- Pediatric Neurosurgery Service, Department of Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
| | - Jean-Claude Decarie
- Department of Radiology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Louis Crevier
- Pediatric Neurosurgery Service, Department of Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Alexander G Weil
- Pediatric Neurosurgery Service, Department of Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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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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Kalovidouri A, Boto J, Vargas MI. Cerebral CSF cyst as a rare complication of ventriculoperitoneal shunt. J Neuroradiol 2016; 43:303-5. [PMID: 27157325 DOI: 10.1016/j.neurad.2016.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
- A Kalovidouri
- Division of Radiology, Geneva University Hospitals and Geneva University, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - J Boto
- Division of Radiology, Geneva University Hospitals and Geneva University, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland; Division of Neuroradiology, Geneva University Hospitals and Geneva University, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - M I Vargas
- Division of Neuroradiology, Geneva University Hospitals and Geneva University, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
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