Published online May 27, 2023. doi: 10.4254/wjh.v15.i5.715
Peer-review started: December 19, 2022
First decision: February 21, 2023
Revised: March 2, 2023
Accepted: April 10, 2023
Article in press: April 10, 2023
Published online: May 27, 2023
Ventriculoperitoneal (VP) shunt placement has become a standard of care procedure in managing hydrocephalus for drainage and absorption of cerebr
A 49-year-old man with history of congenital hydrocephalus status post bilateral VP shunt placement presented with progressively worsening dyspnea on exertion, abdominal discomfort/distention. Abdominal computed tomography (CT) scan revealed a large CSF pseudocyst in the right hepatic lobe with the tip of VP shunt catheter into the hepatic cyst cavity. Patient underwent robotic laparoscopic cyst fenestration with a partial hepatectomy, and repositioning of VP shunt catheter to the right lower quadrant of the abdomen. Follow-up CT demonstrated a significant reduction in hepatic CSF pseudocyst.
A high index of clinical suspicion is required for early detection of liver CSF pseudocysts since their presentation is often asymptomatic and cunning early in the course. Late-stage liver CSF pseudocysts could have adverse outcomes on the treatment course of hydrocephalus as well as on hepatobiliary dysfunction. There is paucity of data to define the management of liver CSF pseudocyst in current guidelines due to rare nature of this entity. The reported occurrences have been managed by laparotomy with debridement, paracentesis, radiological imaging guided fluid aspiration and laparoscopic-associated cyst fenestration. Robotic surgery is an additional minimally invasive option in the management of hepatic CSF pseudocyst; however, its use is limited by lack of widespread availability and cost of surgery.
Core Tip: Liver cerebrospinal fluid (CSF) pseudocysts are a rare subtype of abdominal cysts that are a late complication of ventriculoperitoneal (VP) shunt. The majority of patients are asymptomatic in early stages, however, as the size of the liver CSF pseudocyst increases this may result in ineffective drainage of CSF, thereby aggravating hydrocephalus symptoms. Liver CSF pseudocyst may be confused with other cystic lesions of liver. Early diagnosis and repositioning VP shunt catheter may prevent both neurological and hepatic complications.