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Case Reports
. 2022 May 6:13:195.
doi: 10.25259/SNI_180_2022. eCollection 2022.

Intraparenchymal pericatheter cyst as an indicator of ventriculoperitoneal shunt malfunction: A case-based update

Samuel Teixeira de Oliveira  1 , Joaquim Francisco Cavalcante-Neto  1 , Luís Eduardo Oliveira Matos  1 , Paulo Roberto Lacerda Leal  1 , Espártaco Moraes Lima Ribeiro  1 , Gerardo Cristino-Filho  1 , Keven Ferreira da Ponte  1
Affiliations
Case Reports

Intraparenchymal pericatheter cyst as an indicator of ventriculoperitoneal shunt malfunction: A case-based update

Samuel Teixeira de Oliveira et al. Surg Neurol Int. .

Abstract

Background: Intraparenchymal pericatheter cysts (IPCs) are a rare ventriculoperitoneal shunt (VPS) complication, with only a few cases recorded in the literature.

Case description: We report a 22-year-old woman admitted with headache, papilledema, vision loss, and a history of leukemia. Lumbar puncture revealed idiopathic intracranial hypertension (IIH). Three months after VPS implantation, she was readmitted with headache and worsening of visual impairment. CT evidenced a IPC with perilesional edema. Intraoperatively, a shunt revision and cyst drainage were opted for. We present a discussion and literature review on this unique complication of VPS, with emphasis on management.

Conclusion: It is important to understand and consider IPCs as complications of VPS surgery, including in adult patients and IIH cases.

Keywords: Catheter obstruction; Cerebrospinal fluid edema; Idiopathic intracranial hypertension; Intraparenchymal pericatheter cyst; Ventriculoperitoneal shunt.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Imaging comparison. MRI at admission (before VPS surgery): (a) axial T2 view demonstrating no hydrocephalus. The lumbar puncture confirmed the diagnosis of idiopathic intracranial hypertension. MRI at revaluation (3 months later): (b) lower axial T2, (c) upper axial T2, and (d) parasagittal T2W1 views demonstrating the catheter pathway with an intraparenchymal pericatheter cyst and perilesional edema.
Figure 2:
Figure 2:
Imaging comparison. CT after VPS surgery: (a) coronal view demonstrating the catheter pathway without any parenchymal lesion. CT at revaluation (3 months later): (b) coronal view demonstrating the catheter pathway with an intraparenchymal pericatheter cyst and perilesional edema, without hydrocephalus. CT after shunt revision (postoperative): (c) coronal view demonstrating the new catheter pathway with cyst regression and mild intracystic hemorrhage.
Figure 3:
Figure 3:
Intraoperative image: view of the obstruction of the proximal catheter tip during shunt revision.
See this image and copyright information in PMC

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