title: Chemotherapy-induced cerebrospinal fluid malabsorption in a shunted child: case report and review of the literature.
abstract: Ventriculoperitoneal (VP) shunt insertion is one of the most common neurosurgical procedures for the treatment of chronic hydrocephalus. Although regarded as a relatively benign procedure, several complications including obstruction, infection and mechanical failure can be seen during the postoperative stage. Symptomatic sterile cerebrospinal fluid (CSF) ascites and hydrothoracies are rare complications of VP shunt surgery. The paucity of cases makes identifying the aetiological factors difficult, particularly without catheter tip migration. It is most likely that several factors interact to reduce the absorption of CSF. The authors discuss the case of a 5-year-old girl who developed CSF ascites and a pleural effusion after starting chemotherapy for a suprasellar pilocytic astrocytoma, 2 years post-VP shunt insertion, due to a secondary obstructive hydrocephalus. After the initial management of the presenting symptoms, the child's VP shunt was subsequently changed to a ventriculo-atrial shunt and the patient made an unremarkable recovery. We also review the literature pertaining to this rare complication, assessing identifiable risk factors and surgical management options.
authors: Department of Neurosurgery,  Beaumont Hospital, Dublin,  Ireland.
authors: Philip J
authors: PJ
authors: O'Halloran
authors: Chandrasekaran
authors: C
authors: Kaliaperumal
authors: John
authors: J
authors: Caird
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D001201:Ascites / Q000209:etiology*; D001254:Astrocytoma / Q000134:cerebrospinal fluid / Q000188:drug therapy; D001932:Brain Neoplasms / Q000134:cerebrospinal fluid / Q000188:drug therapy; D002555:Cerebrospinal Fluid / Q000378:metabolism*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010996:Pleural Effusion / Q000209:etiology*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
chemical_list: D000970:Antineoplastic Agents
references: Neurol India. 2000 Dec;48(4):378-80
references: 11146606
references: Br J Neurosurg. 2004 Apr;18(2):171-3
references: 15176560
references: Pediatr Pulmonol. 2012 Jan;47(1):91-5
references: 22170808
references: Childs Nerv Syst. 2005 May;21(5):382-4
references: 15449089
references: Neurol Sci. 2011 Oct;32(5):949-52
references: 21822695
references: Surgery. 1985 Apr;97(4):420-7
references: 3983817
references: Clin Exp Metastasis. 1999;17(10):831-40
references: 11089881
references: Pediatr Neurosurg. 2008;44(1):62-4
references: 18097194
references: Neurosurgery. 1994 Jan;34(1):181-3; discussion 183-4
references: 8121558
references: Childs Nerv Syst. 2012 Nov;28(11):1843-8
references: 22825420
references: Br J Neurosurg. 2011 Apr;25(2):300-2
references: 21158513
references: Childs Nerv Syst. 2001 Jun;17(7):395-8
references: 11465792
references: J Clin Oncol. 2006 May 20;24(15):2283-9
references: 16710025
references: Int J Colorectal Dis. 2007 Apr;22(4):455
references: 16032391
references: Childs Nerv Syst. 2002 Apr;18(3-4):179-82
references: 11981631
references: J Neurosurg. 1982 Sep;57(3):423-5
references: 7097343
references: Childs Nerv Syst. 2006 Sep;22(9):1187-93
references: 16541295
references: Brain Inj. 2004 Aug;18(8):835-44
references: 15204323
references: Childs Nerv Syst. 1997 May;13(5):282-4
references: 9224918
references: Gut. 2012 Feb;61(2):179-92
references: 22057051
references: No Shinkei Geka. 1977 Nov;5(12):1299-303
references: 593523
references: J Neurol Neurosurg Psychiatry. 1976 Jul;39(7):640-6
references: 136498