title: Patient outcomes and surgical complications in coccidioidomycosis-related hydrocephalus: an institutional review.
abstract: OBJECTIVE
  Coccidioidomycosis is a common fungal infection in the southwestern US. Hydrocephalus is a serious complication of cranial coccidioidomycosis, and the surgical management of coccidioidomycosis-related hydrocephalus has unique challenges. The authors reviewed their institutional experience with hydrocephalus in the setting of coccidioidomycosis.
  
  
  METHODS
  The authors retrospectively identified 44 patients diagnosed with coccidioidomycosis-related hydrocephalus at their institution since 1990, who underwent a total of 99 shunting procedures. The authors examined patient demographics, type of shunt and valve used, pressure settings, failure rates, medical treatment, ventricular response to shunting, and other variables.
  
  
  RESULTS
  The majority of patients were young (average age 37 years) men (male/female ratio 28:16) with a mean follow-up of 63 months. Patients of Asian and African descent were overrepresented in the cohort compared with regional demographic data. The overall shunt failure rate during follow-up was 50%, and the average number of revisions required if the shunt failed was 2.5 (range 1-8). Low to moderate draining pressures (mean 88 mm H2O) were used in this cohort. Fourteen patients received intrathecal antifungals, and a trend of initiating intrathecal therapy after need for a shunt revision was observed (p = 0.051). The majority of shunt failures (81%) were due to mechanical blockages in the drainage system. Most patients (59%) had at least partial persistent postoperative ventriculomegaly despite successful CSF diversion. Four patients (9%) died due to coccidioidomycosis during the follow-up period.
  
  
  CONCLUSIONS
  Coccidioidomycosis-related hydrocephalus more often affected young males in the study's cohort, especially those of African and Asian descent. Despite the best medical therapy, there was a high rate of shunt failure due to clogged catheters or valves due to the underlying disease process. Many patients continued to have ventriculomegaly even with adequate CSF diversion. The morbidity and mortality of this chronic disease process must be recognized by the treatment team, and patients should be appropriately counseled.
authors: Divisions of Neurological Surgery and.
authors: Douglas A
authors: DA
authors: Hardesty
authors: Wyatt
authors: W
authors: Ramey
authors: Mohammad
authors: M
authors: Afrasiabi
authors: Brian
authors: B
authors: Beck
authors: Omar
authors: O
authors: Gonzalez
authors: Ana
authors: A
authors: Moran
authors: Peter
authors: P
authors: Nakaji
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020314:Central Nervous System Fungal Infections / Q000150:complications*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D003047:Coccidioidomycosis / Q000150:complications*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000382:microbiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: coccidioidomycosis; hydrocephalus; infection; shunt-related complications