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Child's Nervous System

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01-12-2017 | Review Paper

Treatment of abdominal pseudocysts and associated ventricuoperitoneal shunt failure

Authors: Emily Dzongowski, Kamary Coriolano, Sandrine de Ribaupierre, Sarah A. Jones

Published in: Child's Nervous System | Issue 12/2017

Abstract

Purpose

The purpose of this study was to determine whether drainage and revision are an effective treatment for abdominal pseudocyst associated ventriculoperitoneal (VP) shunt failure by estimating the total rate of secondary shunt failure.

Methods

We performed a retrospective review of children with hydrocephalus diagnosed with and treated for an abdominal pseudocyst at the Children’s Hospital, London Health Sciences Centre (LHSC) between January 1, 2000 and May 31, 2016 (ethics approval # 108136). Patients with a VP shunt were included if (i) the development of an abdominal pseudocyst at age 2 to 18 years was identified, (ii) treatment of the pseudocyst by either interventional radiology (IR) or surgical drainage, and (iii) revision of the VP shunt. Demographic data and details of pseudocyst formation/ treatment as well as subsequent failures were identified.

Results

Twelve patients who had a VP shunt developed abdominal pseudocyst and met inclusion criteria. A 91% shunt failure rate after drainage and shunt revision was identified. Three patients had the pseudocyst drained in interventional radiology and then externalized due to shunt infection. Nine patients were treated by surgical revision. Ten patients experienced recurrent shunt failure following initial drainage of the pseudocyst: pseudocyst reoccurrence (n = 3), distal obstruction from adhesions (n = 1), and uncleared infection (n = 6).

Conclusion

The results suggest that pseudocyst drainage and shunt revision is ineffective in providing long-term resolution of shunt problems.

Ayan E, Tanriverdi HI, Caliskan T, Senel U, Karaarslan N (2015) Intraabdominal pseudocyst developed after ventriculoperitoneal shunt: a case report. J Clin Diagn Res 9:PD05–PD06. https://doi.org/10.7860/jcdr/2015/14064.6114 PubMedPubMedCentral

Carvalho FO, Bellas AR, Guimaraes L, Salomao JF (2014) Laparoscopic assisted ventriculoperitoneal shunt revisions as an option for pediatric patients with previous intraabdominal complications. Arq Neuropsiquiatr 72:307–311CrossRefPubMed

Dabdoub CB, Dabdoub CF, Chavez M, Villarroel J, Ferrufino JL, Coimbra A, Orlandi BM (2014) Abdominal cerebrospinal fluid pseudocyst: a comparative analysis between children and adults. Childs Nerv Syst 30:579–589. https://doi.org/10.1007/s00381-014-2370-2 CrossRefPubMed

de Ribaupierre S, Rilliet B, Vernet O, Regli L, Villemure J-G (2007) Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus: results from a Swiss series and literature review. Childs Nerv Syst 23:527–533CrossRefPubMed

Ersahin Y, Mutluer S, Tekeli G (1996) Abdominal cerebrospinal fluid pseudocysts. Childs Nerv Syst 12:755–758CrossRefPubMed

Gupta N, Park J, Solomon C, Kranz DA, Wrensch M, YW W (2007) Long-term outcomes in patients with treated childhood hydrocephalus. J Neurosurg 106:334–339. https://doi.org/10.3171/ped.2007.106.5.334 PubMed

Gutt CN, Oniu T, Schemmer P, Mehrabi A, Büchler MW (2004) Fewer adhesions induced by laparoscopic surgery? Surg Endosc Other Interv Tech 18:898–906. https://doi.org/10.1007/s00464-003-9233-3 CrossRef

Hamid R, Baba AA, Bhat NA, Mufti G, Mir YA, Sajad W (2016) Postventriculoperitoneal shunt abdominal pseudocyst: challenges posed in management. Asian J Neurosurg. https://doi.org/10.4103/1793-5482.145539

Klimo P Jr, Poppel MV, Thompson CJ, Baird LC, Duhaime A-C, Flannery AM (2014) Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 6: preoperative antibiotics for shunt surgery in children with hydrocephalus: a systematic review and meta-analysis. J Neurosurg Pediatr 14:44–52. https://doi.org/10.3171/2014.7.PEDS14326 CrossRefPubMed

10.

Martin K, Baird R, Farmer JP, Emil S, Laberge JM, Shaw K, Puligandla P (2011) The use of laparoscopy in ventriculoperitoneal shunt revisions. J Pediatr Surg 46:2146–2150. https://doi.org/10.1016/j.jpedsurg.2011.07.001 CrossRefPubMed

11.

McGirt MJ, Zaas A, Fuchs HE, George TM, Kaye K, Sexton DJ (2003) Risk factors for pediatric ventriculoperitoneal shunt infection and predictors of infectious pathogens. Clin Infect Dis 36:858–862. https://doi.org/10.1086/368191 CrossRefPubMed

12.

Mobley LW 3rd, Doran SE, Hellbusch LC (2005) Abdominal pseudocyst: predisposing factors and treatment algorithm. Pediatr Neurosurg 41:77–83. https://doi.org/10.1159/000085160 CrossRefPubMed

13.

Oh A, Wildbrett P, Golub R, Yu LM, Goodrich J, Lee T (2001) Laparoscopic repositioning of a ventriculo-peritoneal catheter tip for a sterile abdominal cerebrospinal fluid (CSF) pseudocyst. Surg Endosc 15:518. https://doi.org/10.1007/s004640000162 CrossRefPubMed

14.

Paiva WS, Andrade AF, Mathias Junior L, Guirado VM, Amorim RL, Magrini NN, Teixeira MJ (2010) Management of supratentorial epidural hematoma in children: report on 49 patients. Arq Neuropsiquiatr 68:888–892CrossRefPubMed

15.

Paiva WSS, Amorim RLO, Figueiredo EG, Pinto FCG, Teixeira MJ (2010) Management of the ventriculoperitoneal shunt infections. Revista Panamericana de Infectología 12:43–47

16.

Pernas JC, Catala J (2004) Case 72: pseudocyst around ventriculoperitoneal shunt. Radiology 232:239–243. https://doi.org/10.1148/radiol.2321011976 CrossRefPubMed

17.

Rekate HL (2000) Hydrocephalus: classification and pathophysiology. In: McLone D (ed) Pediatric neurosurgery: surgery of the developing nervous system. W.B. Saunders, Philadelphia

18.

Roitberg BZ, Tomita T, McLone DG (1998) Abdominal cerebrospinal fluid pseudocyst: a complication of ventriculoperitoneal shunt in children. Pediatr Neurosurg 29:267–273CrossRefPubMed

19.

Salomao JF, Leibinger RD (1999) Abdominal pseudocysts complicating CSF shunting in infants and children. Report of 18 cases. Pediatr Neurosurg 31:274–278CrossRefPubMed

20.

Sanal M, Laimer E, Haussler B, Hager J (2007) Abdominal cerebrospinal fluid pseudocysts in patients with ventriculoperitoneal shunts: 30 years of experience*. J Indian Assoc Pediatr Surg 12:214–217. https://doi.org/10.4103/0971-9261.40838 CrossRef

21.

Santos de Oliveira R, Barbosa A, Vicente YMAAV, Rubens Machado H (2007) An alternative approach for management of abdominal cerebrospinal fluid pseudocysts in children. Childs Nerv Syst 23:85–90. https://doi.org/10.1007/s00381-006-0183-7 CrossRef

22.

Scherer A, Kaefer M, Ackerman L (2014) Severe hydronephrosis caused by an infected intra-abdominal fluid collection in a patient with a ventriculoperitoneal shunt. Childs Nerv Syst 30:1121–1123. https://doi.org/10.1007/s00381-013-2322-2 CrossRefPubMed

23.

Shah HC, Mittal DH, Shah JK (2015) Abdominal cerebrospinal fluid pseudocysts in children: a complication of ventriculoperitoneal shunt. Indian. J Neurosurg 4:049–051

24.

Sharifa A-D (2014) Ventriculoperitoneal shunt with communicating peritoneal & subcutaneous pseudocysts formation. Int J Health Sci 8:107–111CrossRef

25.

Simon TD, Hall M, Riva-Cambrin J, Albert JE, Jeffries HE, Lafleur B, Dean JM, Kestle JR (2009) Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States. J Neurosurg Pediatr 4:156–165. https://doi.org/10.3171/2009.3.PEDS08215 CrossRefPubMedPubMedCentral

26.

Stein SC, Guo W (2008) Have we made progress in preventing shunt failure? A critical analysis. J Neurosurg Pediatr 1:40–47. https://doi.org/10.3171/PED-08/01/040 CrossRefPubMed

27.

Stone JJ, Walker CT, Jacobson M, Phillips V, Silberstein HJ (2013) Revision rate of pediatric ventriculoperitoneal shunts after 15 years. J Neurosurg Pediatr 11:15–19. https://doi.org/10.3171/2012.9.PEDS1298 CrossRefPubMed

28.

Tamber MS, PK J, Mazzola CA, Flannery AM (2014) Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 8: management of cerebrospinal fluid shunt infection. J Neurosurg Pediatr 14:60–71. https://doi.org/10.3171/2014.7.PEDS14328 CrossRefPubMed

29.

Tomiyama A, Harashina J, Kimura H, Ito K, Honda Y, Yanai H, Iwabuchi S (2014) An intra-abdominal pseudocyst around a ventriculoperitoneal shunt due to streptococcus infection 7 years after shunt surgery. Surg Res Pract 2014. https://doi.org/10.1155/2014/898510

30.

Tuli S, Tuli J, Drake J, Spears J (2004) Predictors of death in pediatric patients requiring cerebrospinal fluid shunts. J Neurosurg 100:442–446. https://doi.org/10.3171/ped.2004.100.5.0442 PubMed

31.

Vinchon M, Fichten A, Delestret I, Dhellemmes P (2003) Shunt revision for asymptomatic failure: surgical and clinical results. Neurosurgery 52:347–353 discussion 353-346CrossRefPubMed

32.

Wang B, Hasadsri L, Wang H (2012) Abdominal cerebrospinal fluid pseudocyst mimicking full-term pregnancy. J Surg Case Rep 2012:6–6. https://doi.org/10.1093/jscr/2012.7.6 CrossRefPubMedPubMedCentral

33.

Wu Y, Green NL, Wrensch MR, Zhao S, Gupta N (2007) Ventriculoperitoneal shunt complications in California: 1990 to 2000. Neurosurgery 61:557–562; discussion 562-553. https://doi.org/10.1227/01.NEU.0000290903.07943.AF CrossRefPubMed

34.

Yamashita K, Yonekawa Y, Kawano T, Ihara I, Taki W, Kobayashi A, Handa Y, Kaku Y (1990) Intra-abdominal cyst following revision of ventriculoperitoneal shunt--case report. Neurol Med Chir (Tokyo) 30:748–752CrossRef

35.

Yuh S-J, Vassilyadi M (2012) Management of abdominal pseudocyst in shunt-dependent hydrocephalus. Surg Neurol Int 3:146. https://doi.org/10.4103/2152-7806.103890 CrossRefPubMedPubMedCentral

Title: Treatment of abdominal pseudocysts and associated ventricuoperitoneal shunt failure
Authors: Emily Dzongowski
Kamary Coriolano
Sandrine de Ribaupierre
Sarah A. Jones
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 12/2017
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-017-3609-5

At a glance: The STEP trials

Springer Medicine

Treatment of abdominal pseudocysts and associated ventricuoperitoneal shunt failure

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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