Adityawarma Anak Agung Ngurah Agung Harawikrama, Lauren Christopher, Saputra Angky, Sutikno Joshua, Maliawan Made Gemma Daniswara, Mahadewa Tjokorda Gde Bagus
Neurosurgery Division, Department of Surgery, Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Indonesia.
Surg Neurol Int. 2025 Jan 24;16:19. doi: 10.25259/SNI_754_2024. eCollection 2025.
Ventriculoperitoneal (VP) shunt placement, a common treatment for hydrocephalus, can lead to various complications, including the formation of cerebrospinal fluid (CSF) pseudocysts within the peritoneal cavity. Although rare, occurring in 1-4.5% of cases, these pseudocysts pose significant clinical challenges due to their potential recurrence and the complexity of their management. The optimal management strategy depends on individual patient factors and the presence of infection.
A 24-year-old woman presented with decreased consciousness, worsening headaches, and progressive abdominal enlargement. Imaging revealed a giant intraperitoneal cystic lesion, initially suspected to be a malignant ovarian cyst, but later identified as a CSF pseudocyst associated with the distal tip of a VP shunt placed 9 years earlier. The patient underwent urgent shunt revision, converting to a ventriculoatrial shunt. Postoperatively, her neurological status improved, and the abdominal mass resolved completely within 3 weeks. Follow-up over 1 year confirmed the absence of recurrence or neurological deficits.
VP shunt-associated intraperitoneal CSF pseudocysts, while rare, can develop long after shunt placement and present significant diagnostic and management challenges. Early recognition and appropriate surgical intervention are crucial to prevent complications. This case underscores the importance of individualized treatment approaches and diligent follow-up to ensure favorable outcomes, even in complex cases.
脑室腹腔（VP）分流术是治疗脑积水的常用方法，但可能导致各种并发症，包括在腹腔内形成脑脊液（CSF）假性囊肿。这些假性囊肿虽然罕见，发生率为1%-4.5%，但由于其可能复发以及管理的复杂性，给临床带来了重大挑战。最佳管理策略取决于个体患者因素和是否存在感染。
一名24岁女性出现意识减退、头痛加重和腹部进行性肿大。影像学检查发现一个巨大的腹腔内囊性病变，最初怀疑是恶性卵巢囊肿，但后来确定为与9年前放置的VP分流管远端相关的脑脊液假性囊肿。患者接受了紧急分流管修复术，改为脑室心房分流术。术后，她的神经状态有所改善，腹部肿块在3周内完全消失。1年的随访证实没有复发或神经功能缺损。
VP分流管相关的腹腔内脑脊液假性囊肿虽然罕见，但可在分流术后很长时间出现，带来重大的诊断和管理挑战。早期识别和适当的手术干预对于预防并发症至关重要。该病例强调了个体化治疗方法和密切随访的重要性，以确保即使在复杂病例中也能取得良好的结果。
