Ascites following ventriculoperitoneal shunting in children with chiasmatic-hypothalamic glioma.
OBJECTIVE
Optic pathway gliomas in children can involve the optic nerve, chiasm, and hypothalamus. This uncommon, slowly growing tumor can cause hydrocephalus, which usually requires placement of a ventriculoperitoneal (VP) shunt. Symptomatic ascites may occasionally develop as a complication of the VP shunt procedure. The purpose of this study was to assess the risk factors associated with CSF ascites in children with optic pathway gliomas.


METHODS
Twenty-two children (ages 4 months to 20 years) with chiasmatic-hypothalamic optic gliomas participated in this study. Four children were diagnosed with a chiasmatic glioma, 7 with a hypothalamic glioma, and 11 with a glioma involving both the optic chiasm and hypothalamus. Twelve children (55%) developed hydrocephalus and required VP shunt placement. Of the 12 shunted children, 4 (33%) developed CSF ascites. The incidence of ascites was not associated with infection, tumor metastasis, or multiple shunt revisions. There was no correlation with the size of the tumor. All 4 children with ascites had tumor involving the optic chiasm or optic nerve. None of the 5 children with pure hypothalamic glioma who underwent VP shunt placement have developed ascites. Among the 7 children suffering from chiasmatic or optic nerve gliomas who developed hydrocephalus, the risk of developing ascites as a complication of VP shunt placement was 57% (4/7). Ventriculoatrial (VA) shunt was the treatment of choice for children with VP shunt-induced ascites. After placement of a VA shunt the ascites subsided. The children did not develop further complications.


CONCLUSIONS
We conclude that glioma involving the optic chiasm or nerve is associated with a high risk of developing ascites following VP shunt placement. VA shunt may be the treatment of choice for children with chiasmatic or optic nerve gliomas who require a CSF diversion procedure.
Gil
Z
Z
Division of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Israel.
Beni-Adani
L
L
Siomin
V
V
Nagar
H
H
Dvir
R
R
Constantini
S
S
D000293:Adolescent; D000328:Adult; D001201:Ascites / Q000209:etiology* / Q000601:surgery; D001932:Brain Neoplasms / Q000150:complications* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005910:Glioma / Q000150:complications* / Q000473:pathology; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D007031:Hypothalamus / Q000473:pathology; D007223:Infant; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D009897:Optic Chiasm / Q000473:pathology; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*