The use of ventriculoperitoneal shunts for uncontrollable intracranial hypertension without ventriculomegally secondary to HIV-associated cryptococcal meningitis

Graeme F. Woodworth, Matthew J. McGirt, Michael A. Williams, Daniele Rigamonti

Research output: Contribution to journalArticle

Abstract

Background: The risks associated with implanting a cerebrospinal fluid (CSF) shunt in immunocompromised patients with ongoing CSF infection have historically discouraged surgeons from implanting CSF shunts in patients with HIV and cryptococcal meningitis. However, this patient population often requires frequent lumbar punctures to manage elevated intracranial pressure (ICP) secondary to cryptococcal infection. To date, only 7 cases of ventriculoperitoneal (VP) shunting for the treatment of intracranial hypertension in patients with HIV-associated cryptococcal meningitis have been reported. Few of these reports have included outcomes more than 3 months postsurgery. It remains unclear if VP shunts are an effective long-term treatment of intracranial hypertension in this patient population. Case Descriptions: Two patients with HIV/AIDS (CD4 counts of 8 and 81 cells/mm 3) presented with altered mental status, visual changes, florid cryptococcal meningitis, and elevated ICP (>500 mm CSF) without evidence of hydrocephalus on computed tomography scan. Both patients experienced rapid reversal of symptoms with external lumbar CSF drainage, and remained lumbar drain-dependent after 2 weeks of amphotericin B and flucytosine therapy. Despite evidence of unresolved cryptococcal meningitis, each patient underwent implantation of a VP shunt without complication and was discharged on lifetime fluconazole therapy. They remained asymptomatic at 12 and 16 months after surgery without evidence of shunt infection or malfunction. Conclusion: Patients with intracranial hypertension and HIV-associated cryptococcal meningitis who cannot tolerate cessation of external lumbar CSF drainage or frequent lumbar punctures may be considered for VP shunt placement despite severe immunosuppression and persistent CSF cryptococcal infection.

Original languageEnglish (US)
Pages (from-to)529-531
Number of pages3
JournalSurgical Neurology
Volume63
Issue number6
DOIs
StatePublished - Jun 2005

Fingerprint

Cryptococcal Meningitis
Ventriculoperitoneal Shunt
Intracranial Hypertension
HIV
Cerebrospinal Fluid Shunts
Cerebrospinal Fluid
Spinal Puncture
Infection
Flucytosine
Fluconazole
Immunocompromised Host
Amphotericin B
Therapeutics
Hydrocephalus
CD4 Lymphocyte Count
Immunosuppression
Population
Acquired Immunodeficiency Syndrome
Tomography

Keywords

  • Cerebrospinal fluid shunts
  • Cryptococcal meningitis
  • Elevated intracranial pressure
  • HIV/AIDS

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

The use of ventriculoperitoneal shunts for uncontrollable intracranial hypertension without ventriculomegally secondary to HIV-associated cryptococcal meningitis. / Woodworth, Graeme F.; McGirt, Matthew J.; Williams, Michael A.; Rigamonti, Daniele.

In: Surgical Neurology, Vol. 63, No. 6, 06.2005, p. 529-531.

Research output: Contribution to journalArticle

@article{9a0d43f3e1e94efd960fca1a2ddb3434,
title = "The use of ventriculoperitoneal shunts for uncontrollable intracranial hypertension without ventriculomegally secondary to HIV-associated cryptococcal meningitis",
abstract = "Background: The risks associated with implanting a cerebrospinal fluid (CSF) shunt in immunocompromised patients with ongoing CSF infection have historically discouraged surgeons from implanting CSF shunts in patients with HIV and cryptococcal meningitis. However, this patient population often requires frequent lumbar punctures to manage elevated intracranial pressure (ICP) secondary to cryptococcal infection. To date, only 7 cases of ventriculoperitoneal (VP) shunting for the treatment of intracranial hypertension in patients with HIV-associated cryptococcal meningitis have been reported. Few of these reports have included outcomes more than 3 months postsurgery. It remains unclear if VP shunts are an effective long-term treatment of intracranial hypertension in this patient population. Case Descriptions: Two patients with HIV/AIDS (CD4 counts of 8 and 81 cells/mm 3) presented with altered mental status, visual changes, florid cryptococcal meningitis, and elevated ICP (>500 mm CSF) without evidence of hydrocephalus on computed tomography scan. Both patients experienced rapid reversal of symptoms with external lumbar CSF drainage, and remained lumbar drain-dependent after 2 weeks of amphotericin B and flucytosine therapy. Despite evidence of unresolved cryptococcal meningitis, each patient underwent implantation of a VP shunt without complication and was discharged on lifetime fluconazole therapy. They remained asymptomatic at 12 and 16 months after surgery without evidence of shunt infection or malfunction. Conclusion: Patients with intracranial hypertension and HIV-associated cryptococcal meningitis who cannot tolerate cessation of external lumbar CSF drainage or frequent lumbar punctures may be considered for VP shunt placement despite severe immunosuppression and persistent CSF cryptococcal infection.",
keywords = "Cerebrospinal fluid shunts, Cryptococcal meningitis, Elevated intracranial pressure, HIV/AIDS",
author = "Woodworth, {Graeme F.} and McGirt, {Matthew J.} and Williams, {Michael A.} and Daniele Rigamonti",
year = "2005",
month = "6",
doi = "10.1016/j.surneu.2004.08.069",
language = "English (US)",
volume = "63",
pages = "529--531",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - The use of ventriculoperitoneal shunts for uncontrollable intracranial hypertension without ventriculomegally secondary to HIV-associated cryptococcal meningitis

AU - Woodworth, Graeme F.

AU - McGirt, Matthew J.

AU - Williams, Michael A.

AU - Rigamonti, Daniele

PY - 2005/6

Y1 - 2005/6

N2 - Background: The risks associated with implanting a cerebrospinal fluid (CSF) shunt in immunocompromised patients with ongoing CSF infection have historically discouraged surgeons from implanting CSF shunts in patients with HIV and cryptococcal meningitis. However, this patient population often requires frequent lumbar punctures to manage elevated intracranial pressure (ICP) secondary to cryptococcal infection. To date, only 7 cases of ventriculoperitoneal (VP) shunting for the treatment of intracranial hypertension in patients with HIV-associated cryptococcal meningitis have been reported. Few of these reports have included outcomes more than 3 months postsurgery. It remains unclear if VP shunts are an effective long-term treatment of intracranial hypertension in this patient population. Case Descriptions: Two patients with HIV/AIDS (CD4 counts of 8 and 81 cells/mm 3) presented with altered mental status, visual changes, florid cryptococcal meningitis, and elevated ICP (>500 mm CSF) without evidence of hydrocephalus on computed tomography scan. Both patients experienced rapid reversal of symptoms with external lumbar CSF drainage, and remained lumbar drain-dependent after 2 weeks of amphotericin B and flucytosine therapy. Despite evidence of unresolved cryptococcal meningitis, each patient underwent implantation of a VP shunt without complication and was discharged on lifetime fluconazole therapy. They remained asymptomatic at 12 and 16 months after surgery without evidence of shunt infection or malfunction. Conclusion: Patients with intracranial hypertension and HIV-associated cryptococcal meningitis who cannot tolerate cessation of external lumbar CSF drainage or frequent lumbar punctures may be considered for VP shunt placement despite severe immunosuppression and persistent CSF cryptococcal infection.

AB - Background: The risks associated with implanting a cerebrospinal fluid (CSF) shunt in immunocompromised patients with ongoing CSF infection have historically discouraged surgeons from implanting CSF shunts in patients with HIV and cryptococcal meningitis. However, this patient population often requires frequent lumbar punctures to manage elevated intracranial pressure (ICP) secondary to cryptococcal infection. To date, only 7 cases of ventriculoperitoneal (VP) shunting for the treatment of intracranial hypertension in patients with HIV-associated cryptococcal meningitis have been reported. Few of these reports have included outcomes more than 3 months postsurgery. It remains unclear if VP shunts are an effective long-term treatment of intracranial hypertension in this patient population. Case Descriptions: Two patients with HIV/AIDS (CD4 counts of 8 and 81 cells/mm 3) presented with altered mental status, visual changes, florid cryptococcal meningitis, and elevated ICP (>500 mm CSF) without evidence of hydrocephalus on computed tomography scan. Both patients experienced rapid reversal of symptoms with external lumbar CSF drainage, and remained lumbar drain-dependent after 2 weeks of amphotericin B and flucytosine therapy. Despite evidence of unresolved cryptococcal meningitis, each patient underwent implantation of a VP shunt without complication and was discharged on lifetime fluconazole therapy. They remained asymptomatic at 12 and 16 months after surgery without evidence of shunt infection or malfunction. Conclusion: Patients with intracranial hypertension and HIV-associated cryptococcal meningitis who cannot tolerate cessation of external lumbar CSF drainage or frequent lumbar punctures may be considered for VP shunt placement despite severe immunosuppression and persistent CSF cryptococcal infection.

KW - Cerebrospinal fluid shunts

KW - Cryptococcal meningitis

KW - Elevated intracranial pressure

KW - HIV/AIDS

UR - http://www.scopus.com/inward/record.url?scp=20344389006&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=20344389006&partnerID=8YFLogxK

U2 - 10.1016/j.surneu.2004.08.069

DO - 10.1016/j.surneu.2004.08.069

M3 - Article

C2 - 15936373

AN - SCOPUS:20344389006

VL - 63

SP - 529

EP - 531

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

IS - 6

ER -