Ventriculoperitoneal shunts for treating increased intracranial pressure in cryptococcal meningitis with or without ventriculomegaly

Abstract

Introduction:Cryptococcosis is an opportunistic mycosis, especially in patients that are human immunodefi ciency virus (HIV)-positive, and frequently involves the central nervous system. Methods: We assessed the potential of ventriculoperitoneal shunting (VPS) in preventing mortality due to uncontrollable intracranial hypertension (ICH) in 15 patients with acquired immunodefi ciency syndrome (AIDS)-related cryptococcal meningitis. Results: After 2 weeks of antifungal therapy consisting of amphotericin B deoxycholate with or without fl uconazole, patients with persistent ICH underwent VPS, despite having persistent Cryptococcus neoformans infection. In 12 patients, the uncontrollable ICH was resolved by VPS. Conclusions: Patients with cryptococcal meningoencephalitis who have ICH must be considered for VPS even with positive cerebrospinal fl uid cultures.

Cryptococcal Meningitis: Diagnosis and Management Update

“…In resource limited settings where manometers are not available IV tubing or non-invasive methods such as handheld tonometers or ultrasound to measure intraocular pressure can be used as a surrogate for measuring ICP (61, 62). With persistently elevated ICP, ventriculoperitoneal shunts can be used when conservative measures have failed (63). Other methods of decreasing ICP such as acetazolamide, mannitol, or corticosteroids should not be routinely used (56).…”

Ventriculoperitoneal shunt insertion in human immunodeficiency virus infected adults: a systematic review and meta-analysis

“…33 records were selected for full text review. 8,20,[44][45][46] Nine studies met criteria for inclusion [44][45][46]53,[72][73][74][75]79 and 24 were excluded. 8,20,[54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71]80 All included studies were observational studies.…”

“…Three studies included a total of 75 patients with TBM 44,46,79 and six included a total of 49 patients with CM. 45,53,[72][73][74][75] Excluded studies…”

“…Corti, et al 2014 73 This retrospective interrupted time series included 15 patients with CM who presented to medical services in Buenos Aires, Argentina. 14 of these patients were HIV-infected, however it was not possible to identify which demographic or outcome data pertained to the HIV-non-infected patient.…”

“…VPS was undertaken in all patients using a Medtronic® system, but the valve and catheter model are not documented. The authors define raised opening pressure as ">400cm H 2 0" which, presumably, is a typographic error (raised CSF opening pressure defined as >20-35cm H 2 O in other included studies 45,53,[73][74][75] ). Two patients were described as having This study was classified as being globally weak due to a weak study design and unknown risk of selection bias.…”