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LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 3  |  Page : 341-342

Intraparenchymal pericatheter cyst following ventriculoperitoneal shunt


Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India

Date of Submission18-Feb-2012
Date of Decision01-Apr-2012
Date of Acceptance31-May-2012
Date of Web Publication14-Jul-2012

Correspondence Address:
Jitendra S Shekawat
Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.98534

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How to cite this article:
Shekawat JS, Sundar IV, Poonia N, Sinha VD. Intraparenchymal pericatheter cyst following ventriculoperitoneal shunt. Neurol India 2012;60:341-2

How to cite this URL:
Shekawat JS, Sundar IV, Poonia N, Sinha VD. Intraparenchymal pericatheter cyst following ventriculoperitoneal shunt. Neurol India [serial online] 2012 [cited 2020 Aug 11];60:341-2. Available from: http://www.neurologyindia.com/text.asp?2012/60/3/341/98534


Sir,

Ventriculoperitoneal (VP) shunt is one of the most commonly performed procedures in neurosurgery and the common complications of the procedure include shunt blockage and infection. Intraparenchymal cyst formation in the pericatheter region is a rare but well documented complication with only 10 such reported cases of which one was an adult. [1],[2],[3],[4]

A 65-year-old male patient with CP [Cerebellopontine] angle mass and obstructive hydrocephalus underwent VP shunt initially, and a definitive surgery for the tumor was done a month later through retromastoid suboccipital approach in park bench position with near-total excision of the mass. On the third postoperative day, the patient developed right hemiparesis. Magnetic resonance imaging of brain showed a large cystic lesion with fluid of cerebrospinal fluid (CSF) intensity along the ventricular catheter causing compression on the parietal cortex [Figure 1]. The patient underwent emergency surgery, the shunt was removed, and the cyst was aspirated through the burr hole made for shunt insertion. Postoperatively hemiparesis improved and the patient was discharged after 7 days.
Figure 1: Postoperative MRI showing VP shunt in situ and intraparenchymal pericatheter cyst along shunt path

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The spread of CSF into brain parenchyma is a rare complication of a VP shunt. [1],[2],[3],[4] Such a spread can either form a pericatheter cyst or cause pericatheter CSF edema. [5] The pathogenesis seems to be similar for both. The pressure differential between the intraventricular CSF and brain parenchyma is thought to be the underlying reason for the flow of CSF into brain parenchyma. The consistency of the brain parenchyma at the time of the shunt procedure is thought to be an important determinant. A softer brain is more likely to yield to the CSF pressure, and hence the higher incidence of pericatheter cysts in infants and children. A common feature amongst reported cases of pericatheter cyst seems to be the presence of a blocked shunt. [1],[2],[3],[4] In our patient, the presence of some of inflow holes of ventricular catheter lying in the brain parenchyma was probably the cause of cyst formation. The reason for the cyst to form after the second surgery is unclear though a reduction of intracranial pressure after craniectomy and excision of CP angle tumor might have had a role to play. We hypothesize that the cyst formation was initiated intraoperatively during the surgery for CP angle tumor and it continued to develop for 2-3 days till the distal CSF pathways were patent enough to allow CSF flow through the ventricular system. During this time, the cyst enlarged to a size large enough to cause focal neurological deficit as evidenced by the right hemiparesis. Considering the frequency of ventriculoperitoneal shunt procedures, pericatheter cyst formation is still a very rare complication, but awareness is needed amongst surgeons of the possibility of such an entity. It is also important to emphasize that pericatheter cyst need not form immediately after shunt surgery and should be suspected when there is unexplainable focal deficit after a second surgery. A simple aspiration along with removal of shunt can relieve the pressure effect and the focal neurological deficit. More extensive procedures may be reserved for recurrent cysts or cysts with a patent communication with the ventricle.

 
 » References Top

1.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.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Iqbal J, Hassounah M, Sheikh B. Intraparenchymal pericatheter cyst. A rare complication of ventriculoperitoneal shunt for hydrocephalus. Br J Neurosurg 2000;14:255-8.  Back to cited text no. 2
[PUBMED]    
3.Prasad A, Madan VS, Buxi TB, Renjen PN, Vohra R. The role of the perforated segment of the ventricular catheter in cerebrospinal fluid leakage into the brain. Br J Neurosurg 1991;5:299-302.  Back to cited text no. 3
[PUBMED]    
4.Vajramani GV, Fugleholm K. Reversible CSF cyst related to a function-ing ventriculo-peritoneal shunt. Acta Neurochir (Wien) 2005;147:1199- 202; discussion 1202.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Sakamoto H, Fujitani K, Kitano S, Murata K, Hakuba A. Cerebrospinal fluid edema associated with shunt obstruction. J Neurosurg 1994;81:179-83.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  


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