Dear Gharavi

Salam , I think these articles are interesting for you and i think the CSF is the main cause for ascitis.

yours

Alavian sm

1: Neurol India 2000 Dec;48(4):378-80

CSF ascites: a rare complication of ventriculoperitoneal shunt surgery.

Chidambaram B, Balasubramaniam V.

Department of Neurosurgery, The Childs Trust Hospital, Chennai, 600004, India.

CSF ascites is a very rare complication of ventriculoperitoneal (VP) shunt procedure. No definite explanation has been offered for the inability of the peritoneum to absorb the CSF. Two children who underwent VP shunting for hydrocephalus, presented with ascites 3 (1/2) years and 4 months respectively, after the shunt was placed. The treatment of choice is conversion of the VP shunt to a ventriculoatrial shunt.

PMID: 11146606 [PubMed - indexed for MEDLINE]

2: Pediatr Neurosurg 1999 Nov;31(5):242-5

Thalamic glioblastoma with cerebrospinal fluid dissemination in the peritoneal cavity.

Kumar R, Jain R, Tandon V.

Department of Neurosurgery, Sanjay Gandhi Post-Graduate Institute of Medical

Sciences, Lucknow, India. rajkumar@sgpgi.ac.in

Glioblastoma multiforme is one of the commonest primary malignant tumours of the brain with rare incidence of extracranial metastases. Systemic dissemination via the CSF or CSF diversionary shunt procedures is also rare. The reported 9-year-old child was a case of thalamic glioblastoma with hydrocephalus who underwent biventriculoperitoneal shunting before tumour decompression and radiotherapy. The child developed incapacitating ascites 8 months following surgical decompression and 9 months after the shunt diversion which was found to be caused by CSF dissemination of the glioblastoma via the ventriculoperitoneal shunt. The child ultimately succumbed to his disease. Copyright 2000 S. Karger AG, Basel

Publication Types:

Review

Review of reported cases

PMID: 10681678 [PubMed - indexed for MEDLINE]

3: Intern Med 1998 Jul;37(7):638-41

Cerebrospinal ascites developed 3 years after ventriculoperitoneal shunting in a hydrocephalic patient.

Yukinaka M, Nomura M, Mitani T, Kondo Y, Tabata T, Nakaya Y, Ito S. Second Department of Internal Medicine, School of Medicine, University of Tokushima.

We report a 23-year-old woman who developed ascites 3 years after ventriculoperitoneal shunting. Revision of the shunt to ventricular drainage followed by ventriculo-atrial shunting was required for resolution of ascites. In our patient the pathophysiology of this rare shunt complication most likely involved impaired absorption of fluid within the peritoneum associated with multiple shunt reconstructions and tube extensions resulting in chronic inflammation. Cerebrospinal ascites must be suspected irrespective of post-shunt intervals in similar patients.

Publication Types:

Review

Review of reported cases

PMID: 9711897 [PubMed - indexed for MEDLINE]

4: Med Pediatr Oncol 1997 Jul;29(1):33-5

Optic chiasm glioma, electrolyte abnormalities, nonobstructive hydrocephalus and ascites. Shuper A, Horev G, Michovitz S, Korenreich L, Zaizov R, Cohen IJ. National Center for Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel. A 4-year-old girl with optic chiasm glioma (OCG), nonobstructive hydrocephalus and ventriculoperitoneal shunt is described, in whom marked ascites developed. The ascitic fluid was protein-rich and its amount correlated with cerebrospinal fluid (CSF) protein. The CSF protein level and the amount of ascitic fluid were influenced by chemotherapy. Very unusual hypernatremia, up to 190 mEq/l with no associated alteration in mental status, was also found. It is suggested that altered absorption ability owing to the high protein content was the cause of both the nonobstructive hydrocephalus and the ascites. The unusual well being with very high sodium concentrations may have resulted from osmoreceptor dysfunction, presumably caused by hypothalamic involvement as well as by the high CSF protein. This combination of findings may point toward specific characteristics of OCG. In an effort to reduce the amount of the ascitic fluid, a further chemotherapeutic trial may be done, before converting the shunt to the vetriculoatrial system.

PMID: 9142203 [PubMed - indexed for MEDLINE]

5: Clin Nucl Med 1996 Jul;21(7):586

Scintigraphic findings in cerebrospinal fluid ascites complicating a ventriculoperitoneal shunt.

Phillips WE 2nd, Burke GJ.

Medical College of Georgia, Department of Radiology, Augusta 30912-3900, USA.

PMID: 8818483 [PubMed - indexed for MEDLINE]

6: Pediatr Neurosurg 1994;21(4):254-8; discussion 259

Childhood optic pathway tumors associated with ascites following ventriculoperitoneal shunt placement.

West GA, Berger MS, Geyer JR.

Department of Neurological Surgery, University of Washington and Children's Hospital and Medical Center, Seattle.

Three children with optic pathway gliomas who developed ascites following ventriculoperitoneal shunt placement are presented. In all 3 cases there was an elevated cerebrospinal fluid (CSF) protein level at the time of initial shunt placement. At the time of developing ascites following placement of the ventriculoperitoneal shunt, none of the patients had evidence of infection or tumor seeding in the peritoneal cavity. The ascites completely resolved in each

instance after converting the shunt to a ventriculoatrial system. Ascites following ventriculoperitoneal shunt insertion is an uncommon complication. A review of the literature and discussion of the possible etiologic factors in the development of ascites after ventriculoperitoneal shunt placement are presented. For patients diagnosed with optic gliomas, it is suggested that because the

tumor is widely exposed to the CSF space, protein exuded by the mass into the subarachnoid space will cause an elevated CSF protein concentration. The elevated CSF protein may then lead to ascites as a result of poor absorption of CSF in the peritoneal cavity after placement of a ventriculoperitoneal shunt. Although ascites following ventriculoperitoneal shunt placement is not typical in patients with optic gliomas, attention should be given to CSF protein levels documented at the time of CSF diversion for hydrocephalus, recognizing that

ascites may occur as a result of poor CSF absorption in the periotoneum, subsequently requiring a ventriculoatrial shunt in patients who develop hydrocephalus.

PMID: 7865412 [PubMed - indexed for MEDLINE]

7: Rev Esp Enferm Dig 1993 Apr;83(4):285-7

[A ventriculoperitoneal shunt as a rare cause of ascites].

[Article in Spanish]

Suarez A, Riestra S, Navascues CA, Sotorrio NG, Rodriguez M, Alonso JL, Perez R,

Rodrigo L.

Seccion de Aparato Digestivo, Hospital Covadonga, Oviedo.

We report the case of a 22-year-old man with a craniopharyngioma, who developed ascites following a ventriculoperitoneal shunt procedure for hydrocephalus. The ascites was resolved with diversion of the distal catheter into the right atrium. A ventriculoperitoneal shunt can cause ascites, even without neurological symptoms suggestive of shunt malfunction

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