Intracranial calcified pseudocyst reaction to a shunt catheter

Abstract

<jats:p>A 9-year-old boy with spina bifida, Chiari II malformation, and hydrocephalus presented with signs of increased intracranial pressure consistent with a shunt malfunction. Radiological investigations revealed an intracranial calcified lesion along the ventricular catheter. A shunt tap revealed a translucent milky white fluid. The patient underwent a ventriculostomy and, eventually, a shunt revision. Pathology findings were consistent with the formation of dystrophic calcification and a pseudocyst around the shunt catheter. Postoperatively, the patient returned to his neurological baseline. This is, to the best of the authors' knowledge, the first report of an intracranial calcified pseudocyst in a patient with normal renal function.</jats:p>

Intracranial Dystrophic Calcification of Ventriculoperitoneal Shunt: A Case Report

“…A report by Yowtak et al [10] detailed the first case of intracranial pseudocyst with calcifications around the ventricular catheter but it was not as extensive as in our case. They hypothesized that the calcification started in the subcutaneous tissue producing fluid, which then migrated into the cranium [10].…”

“…They hypothesized that the calcification started in the subcutaneous tissue producing fluid, which then migrated into the cranium [10]. Also, we speculate that our case might have had a small hematoma around the shunt catheters when he had his operation.…”

“…They attributed this complication to abnormal Ca and PO 4 metabolism as a result of his renal failure. Calcification of a VP shunt in subcutaneous tissue may be metastatic and due to elevated Ca and PO 4 or dystrophic with normal levels of Ca and PO 4 but with abnormal cellular metabolism [10]. Our patient has a normal renal profile, and all his laboratory investigations were normal apart from a slightly elevated PO 4 .…”

“…Jimenez et al [17] suggested that the patients’ cellular and humoral immune response as a result of their HLA genotype could cause an adverse reaction to silicone. However, the cellular immune response does not occur in the brain parenchyma as it does in subcutaneous tissue and therefore does not usually cause gliosis around ventricular catheters [10]. Moreover, younger patients tend to have a relatively higher level of phosphate which could explain why VP shunt calcifications tend to occur in the pediatric age group compared to adults [10].…”

“…This might be because of the increased mechanical stress in that region [5, 6, 8, 9]. On the other hand, only a few reports of intracranial calcification of a ventricular catheter were found in the literature [4, 10]. …”