Shunting was performed with bilateral ventricular drains connected proximal to the valve using a “Y” connector and draining to the peritoneal cavity. Postoperative MR imaging showed hydrocephalus due to an obstruction of the foramen of Monro. The outcome of the histological examination was again the same. At that time, the vascularity of the tumor allowed only a limited resection. This operation was performed on the basis of the MR imaging study no new neurological deficits were reported. Subsequent MR imaging revealed renewed tumor growth that led to a third operation at the same institution when the girl was 4years and 8 months old. After the operation, she underwent external beam radiation (40 Gy). At the age of 16 months, she underwent another operation at the same institution and about50% of the tumor was removed. No criteria for neurofibromatosis were identified.Ī routine follow-up MR imaging study demonstrated rapid growth of the initially small remaining tumor to 4 x 3 x 3 cm. Histological examination revealed a low-grade astrocytoma (WHO grade I). She underwent immediate surgery for resection, and two-thirds of the tumor and a part of the right optic nerve were removed. Computed tomography and magnetic resonance (MR) imaging revealed a large tumor (5 x 5 x 5 cm) in the region of the optic chiasm. (A) Gadolinium-enhanced, T1-weighted sagittal magnetic resonance (MR) image and (B) axial T2-weighted MR image showing the optic glioma after three resections and external beam radiation (40 Gy).Īt the age of 6 months, a Caucasian girl was admitted to a children’s hospital elsewhere for evaluation after experiencing nystagmus for 4 weeks. The results of CSF protein electrophoresis suggest that this unusual association of optic gliomas with ascites may reflect a disturbance of the BBB that permits the concentration of protein in the CSF to reach excessive levels. We report another patient with anoptic glioma who developed ascites after VP shunting for hydrocephalus. In seven cases, the CSF ascites was associated with elevated levels of CSF protein and a brain tumor (six optic gliomas and one craniopharyngioma).ĭifferent etiologic factors underlying the development of ascites after VP shunting have been proposed, including the possibility of a defective blood-brain barrier (BBB). 8 CSF ascites after ventriculoperitoneal (VP) shunting, however, is rare: We have found only 22 published reports of this complication. Of all pediatric neurosurgical procedures, cerebrospinal fluid (CSF) shunts carry the highest incidence of complications. Key Words : ascites, blood-brain barrier, electrophoresis, hydrocephalus, optic glioma, ventriculoperitoneal shunt These elevated levels of protein then likely led to the failure of peritoneal absorption of the CSF. The results of electrophoresis suggest that the severely elevated levels of CSF protein reflected a disturbed blood-brain barrier. The CSF as well as the ascites fluid contained elevated protein concentrations (375 mg/dl and 1600 mg/dl, respectively). The ascites completely resolved after the shunt was converted to a ventriculoatrial system. There was no evidence of CSF or peritoneal infection or tumor seeding into the peritoneal cavity. The VP shunt was placed to treat non communicating hydrocephalus caused by an optic glioma. †Department of Neurosurgery, ‡Department of Pediatrics, University of Graz, Austria, †‡Zentrum fur Blut- und Krebserkrankungen, Berlin, GermanyĪ 5.5-year-old girl developed cerebrospinal fluid (CSF) ascites after ventriculoperitoneal (VP) shunting. Department of Translational Neuroscienceĭivision of Neurological Surgery, Barrow Neurological Institute, Mercy Healthcare Arizona, Phoenix, Arizona.Department of Physical Medicine & Neuro-Rehabilitation.Department of ENT and Skull Base Surgery. Barrow-ASU Center for Preclinical Imaging.Bioskills & Neurosurgery Research Laboratory.Parkinson’s Disease & Movement Disorders.Center for Transitional Neuro-Rehabilitation.
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