We report a case of choroid plexus papilloma of the left lateral ventricle, which illustrates the difficulties of diagnosis of these tumours with air studies in advanced hydrocephalus. The hydrocephalus was apparent at the age of three months, but ventriculography failed to reveal the true nature of the communicating hydrocephalus. A ventriculocaval shunt was inserted, but the hydrocephalus progressed, in spite of the fact that the shunt was functioning well. The diagnosis of a papilloma of the choroid plexus was made after performing a CT examination at the age of 3 1/2 years. In spite of radical tumour removal, three years after the operation the axial computer tomography revealed a persistent hydrocephalus, but no recurrence of tumour. To control the hydrocephalus, a bilateral shunt with low pressure valve was necessary. With reference to the literature we discuss the possible causes of persistent hydrocephalus after surgical removal of these tumours. The majority of authors concluded, that because of repeated subarachnoid bleeding by these tumours, it must be a form of aresorptive hydrocephalus. The persisting hydrocephalus is probably caused by an increase of the CSF outflow resistance because of a distal CSF-pathway obstruction.
The intrathecal infusion test leads to a more accurate diagnosis of communicating hydrocephalus, and is useful in identifying those patients with insufficient cerebrospinal fluid (CSF) absorption who are most likely to improve after a shunt operation. Furthermore, shunt function can be evaluated by assessing the CSF absorption of shunt-operated patients in the same way. Some patients do not improve after surgery because of irreversible or shunt-independent neurological and radiological signs, while the postoperative infusion test demonstrates a normal shunt function. The clinical condition and neuroradiological picture of such patients cannot be improved by shunt revision if the implanted shunt already allows a normal CSF outflow. By means of infusion tests the number of patients who need a further operation can be reduced, with a consequent drop in shunt infections, a very welcome aspect especially in pediatric neurosurgery. In our department 298 infusion tests were carried out over a seven-year period, and a decrease in shunt revisions and infections could be observed.
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