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Evolving Surgical Management of Cerebrospinal Fluid Pseudocyst of the Abdomen (Abstract)

Rakesh Handa¹, Ravi Kale², Man Mohan Harjai³
¹Department of Pediatric Surgery, Max Super Speciality Hospital, New Delhi, India
²Chief, Division of Surgery and Head, Department of Pediatric Surgery, Command hospital, Lucknow, India 
³Department of Pediatric Surgery, Surgical Division, Base Hospital Delhi Cantt, New Delhi, India (affiliated to army College of medical Sciences)



Background: Laparoscopic evaluation and management of cerebrospinal fluid (CSF) pseudocyst is an effective technique for diagnosing and treating this condition. It eliminates the need to subject the child to repeated laparotomy and offers a minimally invasive method to deal with this distressing entity.

Material and methods: We present our experience with distal catheter complications managed by open method as well as laparoscopically. Total of nine children who presented to a Pediatric Surgery Centre over an 11-year period from June 1994 to June 2005 are included in this retrospective study. There were 3 girls and 6 boys and their ages ranged from 9 months to 5 years. The etiology in these patients was tubercular meningitis in three, post meningomyelocele hydrocephalus in four, congenital hydrocephalus in one and intra-ventricular hemorrhage in one case.

Results: Four children presented with abdominal signs of a mass and five children presented with features of shunt malfunction and raised intra cranial pressure. Seven children underwent laparotomy for drainage of the pseudocyst and reposition of the shunt. Of these, five children responded to a single surgical intervention and repositioning of the shunt while one child required two interventions and one child had three surgical interventions before settling down. Laparoscopic de-roofing of the cerebrospinal fluid pseudocyst and reposition of the shunt in the sub-diaphragmatic space was done in two children. The mean hospital stay for cases undergoing open surgery was 12.8 days while the hospital stay in cases managed laparoscopically was only 3.5 days. Conclusions: However, despite the trend to manage these cases laparoscopically, a large series and adequate follow up only will establish this procedure as the accepted treatment modality of cerebrospinal fluid pseudocyst of the abdomen. 

Key words: cerebrospinal fluid pseudocyst, ventriculoperitoneal shunt, distal catheter complications, laparoscopic management, laparotomy.