Lin Xiumei, He Guowei, Li Qianning, Yang Xiaohua, Zheng Xingrong, Wang Lu, Yan Ying, Zhang Yeqiong
Department of Clinical Laboratory, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong, China.
Pathology Department, Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, 510095, Guangdong, China.
Neurosurg Rev. 2025 Aug 8;48(1):593. doi: 10.1007/s10143-025-03753-1.
Cryptococcal meningitis (CM) is a life-threatening fungal infection of the central nervous system, with intracranial hypertension being a major contributor to mortality. Ventriculoperitoneal (VP) shunting has been established as a crucial intervention for managing elevated intracranial pressure; however, comprehensive long-term prognostic data for CM patients undergoing VP shunt placement remain limited. This study aimed to evaluate the long-term outcomes of VP shunting in patients with CM through a retrospective analysis. A retrospective cohort study was conducted involving patients diagnosed with CM, with a follow-up period of 48 weeks. Demographic characteristics, disease-related parameters, and laboratory findings were collected and analyzed at multiple time points. Of the 106 CM patients enrolled, 77 underwent VP shunting, while 29 received conservative management. No significant differences were observed between the two groups in terms of hospitalization duration, cryptococcal clearance rate, time to cerebrospinal fluid (CSF) culture negativity, or recurrence rate. The VP shunt group demonstrated a rapid reduction in intracranial pressure (ICP), achieving normalization by week 4 and maintaining a significantly lower level than the conservative group at week 12. CSF cryptococcal counts were comparable between the groups throughout the follow-up period. However, the VP shunt group exhibited persistently elevated CSF white blood cell (WBC) counts and protein levels up to 48 weeks, along with transiently lower glucose levels in the early stages, which normalized by week 24. VP shunting effectively controls intracranial hypertension and accelerates cryptococcal clearance in patients with CM; however, it does not significantly alter the long-term clinical prognosis, and the clinical significance of postoperative CSF alterations may be limited.
隐球菌性脑膜炎（CM）是一种危及生命的中枢神经系统真菌感染，颅内高压是导致死亡的主要因素。脑室腹腔（VP）分流术已被确立为治疗颅内压升高的关键干预措施；然而，关于接受VP分流术的CM患者的全面长期预后数据仍然有限。本研究旨在通过回顾性分析评估CM患者VP分流术的长期疗效。进行了一项回顾性队列研究，纳入诊断为CM的患者，随访期为48周。在多个时间点收集并分析人口统计学特征、疾病相关参数和实验室检查结果。在纳入的106例CM患者中，77例行VP分流术，29例接受保守治疗。两组在住院时间、隐球菌清除率、脑脊液（CSF）培养转阴时间或复发率方面均未观察到显著差异。VP分流术组颅内压（ICP）迅速降低，在第4周恢复正常，并在第12周时维持在显著低于保守治疗组的水平。在整个随访期间，两组的CSF隐球菌计数相当。然而，VP分流术组在长达48周的时间里CSF白细胞（WBC）计数和蛋白水平持续升高，早期血糖水平短暂降低，并在第24周恢复正常。VP分流术可有效控制CM患者的颅内高压并加速隐球菌清除；然而，它并未显著改变长期临床预后，术后CSF改变的临床意义可能有限。
