Ventriculoperitoneal shunt for cerebrospinal fluid fistula treatment
A 2-year-old patient with a known diagnosis of Chiari malformation and syringomyelia underwent posterior fossa duroplasty. Unfortunately, during the postoperative course, the patient presented with CSF leakage through the surgical wound. The leakage was associated with a risk of infection and delayed wound healing. Prompt intervention was crucial to prevent further complications.
Management and Treatment: Following a multidisciplinary discussion, it was decided that ventriculoperitoneal (VP) shunt placement and wound revision were the most appropriate management strategies. Informed consent was obtained from the parents, and the procedure was scheduled for the following day. The VP shunt placement aimed to redirect CSF drainage, relieving pressure on the surgical wound and promoting healing. Simultaneously, wound revision ensured adequate closure and minimized the risk of persistent leakage.
Outcome and Follow-up: The patient successfully underwent VP shunt placement and wound revision without any intraoperative complications. Postoperatively, close monitoring of CSF leakage, wound healing, and general well-being was implemented. Regular follow-up appointments were scheduled to assess the effectiveness of the intervention, evaluate wound healing progress, and monitor for any signs of shunt malfunction or infection.
Discussion: CSF leakage is a recognized complication following surgical intervention for Chiari malformation. Prompt diagnosis and appropriate management are essential to minimize associated risks and improve patient outcomes. In this case, VP shunt placement and wound revision provided a comprehensive approach to address CSF leakage, promoting healing and reducing the risk of complications.
Conclusion: CSF leakage following surgical intervention for Chiari malformation poses challenges in the management of pediatric patients. Timely recognition, interdisciplinary collaboration, and appropriate intervention, such as VP shunt placement and wound revision, are crucial for successful resolution. This case report highlights the importance of individualized treatment plans and the need for close follow-up to ensure optimal patient care.
Spontaneous skull base cerebrospinal fluid (CSF) leaks due to idiopathic intracranial hypertension (IIH) are a rare entity. Patients often present with CSF rhinorrhea, recurrent meningitis, chronic headache, and visual defects, while few patients have been reported to present with neuroendocrine alterations. Endonasal endoscopic repair is the first-line treatment for these leaks at present. However, the relatively high risk of recurrence remains the main cause of reoperation because of elevated intracranial pressure (ICP) after endoscopic surgery and absence of postoperative ICP management. A shunting procedure may stop CSF leakage or relieve symptoms in complex cases, and this is presently well-known as the last-line therapy for CSF liquorrhea. We describe a 29-year-old woman with spontaneous CSF rhinorrhea and neuroendocrine alterations due to IIH, and with no previous history of trauma, tumor, or nasal surgery. The bone defect in the skull base became implicated when the site of the leak was detected by cranial magnetic resonance imaging and computed tomography (CT). The patient was successfully managed via ventriculoperitoneal shunt (VPS) alone without endoscopic repair, and neuroendocrine alterations resolved after the shunting procedure 1)