title: Thinking outside the shunt-sterile CSF malabsorption in pilocytic astrocytomas: case series and review of the literature.
abstract: BACKGROUND
  Ventriculoperitoneal (VP) shunt insertion is the most common cerebrospinal fluid (CSF) diversionary procedure used for the treatment of chronic hydrocephalus. Sterile CSF ascites is a rare complication of VP shunt insertion. This can arise from either an overproduction of CSF or inadequate filtration of CSF at the level of the peritoneum. By either mechanism, the development of CSF ascites requires an intact VP shunt.
  
  
  OBJECTIVE
  The authors discuss two paediatric cases diagnosed with suprasellar pilocytic astrocytomas treated with platinum-based chemotherapy, who subsequently developed sterile CSF ascites. We review the literature with regard to CSF malabsorption and discuss it as a contributing factor to shunt malfunction.
  
  
  CONCLUSIONS
  CSF malabsorption with resultant ascites is a rare complication of VP shunting with many etiologies. Two common predisposing factors included the use of platinum-based chemotherapeutic agents, as well as the specific neuropathology. Further analysis of these two entities is needed in order to elucidate their role in contributing to the development of CSF ascites in this patient cohort.
authors.affiliation: Department of Neurological Surgery, Cork University Hospital, Corcaigh, Ireland.
authors.forename: J A
authors.initials: JA
authors.lastname: Johnson
authors.affiliation: Department of Neurological Surgery, Cork University Hospital, Corcaigh, Ireland. phiohalloran@rcsi.ie.
authors.forename: P J
authors.initials: PJ
authors.lastname: O'Halloran
authors.affiliation: Department of Paediatric Neurosurgery, Children's University Hospital, Temple Street, Dublin 1, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Crimmins
authors.affiliation: Department of Paediatric Neurosurgery, Children's University Hospital, Temple Street, Dublin 1, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Caird
mesh_terms: D001201:Ascites / Q000209:etiology*; D001254:Astrocytoma / Q000150:complications*; D002555:Cerebrospinal Fluid; D002675:Child, Preschool; D005260:Female; D006801:Humans; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
keywords: CSF ascites; Chemotherapy; Optic pathway Gliomas; VP shunt