CSF protein concentration associated with ventriculoperitoneal shunt obstruction in tuberculous meningitis

Kamat, Ameya S.; Gretschel, Armin; Vlok, Adriaan; Solomons, Regan

doi:10.5588/ijtld.17.0008

Cited by 24 publications

(34 citation statements)

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“…26 But to recommend the routine use navigation system for the insertion shunt, we need a multicentric study with large sample size. Ambekar et al 27 and Kamat et al 28 showed in their study that patients with increased protein levels in CSF are at a high risk of VP shunt blockage. In our study, we found more complications in the patients with elevated CSF protein of more than 40 mg per deciliter.…”

Section: Discussionmentioning

confidence: 95%

A Prospective Study and Analysis of Ventriculoperitoneal Shunt Surgery: Their Indication and Complication in a Single Tertiary Care Center

Pal

Dhar

Sahu

et al. 2021

Indian Journal of Neurosurgery

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Background Ventriculoperitoneal (VP) shunt insertion is routinely performed for the treatment of hydrocephalus due to different indications like congenital, infective, tumor, posttraumatic, and normal pressure hydrocephalus (NPH). A lot of common and rare complications following this procedure have been reported. Objectives To analyze the clinical profile, indications, anesthetic, and postoperative complications for VP shunt surgery in our center. Materials and Methods This prospective clinical review study was conducted in the Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, between October 2018 to January 2020 and included 454 cases of hydrocephalus who underwent VP shunt surgery. The data was compiled and analyzed. Results A total of 454 patients with male predominance were studied. Pediatric and adolescent patients were 48.9% (222/454). Obstructive hydrocephalus due to tumors was the etiology of 48.7% (221/454) cases. The incidence of overall shunt complications was 9.7% (44/454), of which obstruction and infection was 5.9% (27/454) and 3.1% (14/454), respectively. Factors associated with increased shunt complications include redo and infective etiology and cases having higher protein in perioperative cerebrospinal fluid (CSF) analysis. Neuronavigation, antibiotic-impregnated shunt and biventricular shunt are associated with lower complications. Conclusion Obstructive hydrocephalus due to tumors happened to be the most common cause of VP shunt, and shunt obstruction is most common complication, especially in infective and redo cases.

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Section: Discussionmentioning

confidence: 95%

A Prospective Study and Analysis of Ventriculoperitoneal Shunt Surgery: Their Indication and Complication in a Single Tertiary Care Center

Pal

Dhar

Sahu

et al. 2021

Indian Journal of Neurosurgery

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“…Kamat et al described in his study the levels of CSF proteins when quantified in relation to the VP shunt functioning. 11 He found that with higher levels of protein, reaching up to 2.0 g/L in the CSF, the risk of VP shunt blockage increased. 11 is a rare complication of VP shunt; however, in cases of some brain tumours such as optic pathway gliomas, it can be present.…”

Section: Discussionmentioning

confidence: 99%

“…11 He found that with higher levels of protein, reaching up to 2.0 g/L in the CSF, the risk of VP shunt blockage increased. 11 is a rare complication of VP shunt; however, in cases of some brain tumours such as optic pathway gliomas, it can be present. 11 It is suggested that high levels of CSF protein in optic glioma are due to its wide exposure to CSF space, which allows the tumour proteins to easily pass through the CSF and lead to poor absorption and obstruction of the VP shunt.…”

Section: Discussionmentioning

confidence: 99%

“…11 is a rare complication of VP shunt; however, in cases of some brain tumours such as optic pathway gliomas, it can be present. 11 It is suggested that high levels of CSF protein in optic glioma are due to its wide exposure to CSF space, which allows the tumour proteins to easily pass through the CSF and lead to poor absorption and obstruction of the VP shunt. 12 In this case, other cavities can be used, such as atrial cavity or gallbladder cavity.…”

Section: Discussionmentioning

confidence: 99%

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Management of ventriculo-gallbladder shunt in the presence of gallstones

et al. 2020

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Hydrocephalus is a prevalent health problem that is frequently encountered by paediatric neurosurgeons during infancy and childhood. We report a case of an 11-year-old boy with high cerebrospinal fluid protein hydrocephalus secondary to optic glioma that required a ventriculoperitoneal (VP) shunt. The patient had multiple failures of VP shunt and developed massive ascites. Alternatively, the hydrocephalus was treated by ventriculo-gallbladder (VG) shunt in the presence of sludge which was removed from the gallbladder before placement of the shunt. After VG shunt insertion, the patient expressed signs of infection with elevated liver profile, which emphasised the presence of gallstones. While the shunt was kept in its place without any complications, the gallstones were successfully removed by an endoscopic retrograde cholangiopancreatography. In conclusion, the presence of sludge is not a contraindication for VG shunt placement, and, if the VG shunt was complicated with gallstones, it could be treated without the need for cholecystectomy.

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“…[1][2][3][4] White blood cells and high CSF protein levels are risk factors for shunt occlusion, and it is well known in neurosurgical practice that shunts occlude when there are high levels of CSF protein and cells. 5,6 Persistently elevated CSF protein levels immediately after shunt obstruction may indicate early deposition of debris within the valve as a result of ongoing pathological CSF processes, which will eventually cause shunt malfunction. 1 Also, ventriculoperitoneal shunt (VP-shunt) may be followed by ascites development as a result of poor CSF absorption in the peritoneal cavity in patients with optic pathway gliomas (OPG).…”

Section: Introductionmentioning

confidence: 99%

Reduction in the cerebrospinal fluid protein level after bevacizumab treatment in patients with optic pathway low‐grade gliomas

Costa

Watanabe

Soares

et al. 2022

Pediatric Blood & Cancer

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Optic pathway gliomas (OPG) can cause elevated cerebrospinal fluid (CSF) protein concentrations. We report on two patients with suprasellar low-grade gliomas and high CSF protein levels (590 and 551 mg/dl) that precluded shunt implantation. After two and three doses of bevacizumab, respectively, the levels dropped dramatically to 191 and 178 mg/dl, respectively. Bevacizumab treatment was associated with a decrease in CSF protein level, allowing successful shunt placement. Our results are consistent with the pharmacological mechanism of bevacizumab, which decreases protein leakage from blood vessels to the ventricles.

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CSF protein concentration associated with ventriculoperitoneal shunt obstruction in tuberculous meningitis

Abstract: Patients with increased protein levels in CSF are at a high risk of VPS blockage. In these patients, temporary measures should be employed until CSF protein levels decrease.

Cited by 24 publications

References 0 publications

A Prospective Study and Analysis of Ventriculoperitoneal Shunt Surgery: Their Indication and Complication in a Single Tertiary Care Center

A Prospective Study and Analysis of Ventriculoperitoneal Shunt Surgery: Their Indication and Complication in a Single Tertiary Care Center

Management of ventriculo-gallbladder shunt in the presence of gallstones

Reduction in the cerebrospinal fluid protein level after bevacizumab treatment in patients with optic pathway low‐grade gliomas

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