Abstract
Objective Shunt dependency syndrome after cyst-peritoneal (CP) shunt is a rare but serious
complication which leads to increased intracranial pressure and neurological deficit.
The possible mechanism still remains in controversy. We present our experience on
the treatment of the complication and attempt to find a better therapy strategy for
the complication.
Methods Two children with middle fossa arachnoid cysts underwent CP shunt with fixed pressure
catheters at an opening pressure of 7 cmH2O and then developed dependency syndrome. Both patients were effectively treated by
mini-invasive cyst wall excision with the shunts reserved. The clinical manifestation,
radiological findings, treatment methods, and therapeutic outcomes were reviewed retrospectively.
Results The time from shunt surgery to shunt dependency syndrome occurrence was 4 and 2 years,
respectively. Computed tomography/magnetic resonance findings of the brain showed
remarkably collapsed cysts with normal or small ventricles. Both patients underwent
secondary mini-invasive cyst wall excision and shunt catheters were reserved. After
the operations, their symptoms were resolved except one case with marginally improved
visual impairment.
Conclusion Shunt dependency syndrome is a rare but dangerous complication of CP shunt and should
be treated in time. Collapsed and thickened cyst wall intermittent covering the catheter
head end, decreased brain compliance due to chronic fibrosis, as well as regression
of cerebrospinal fluid absorption could be the pathogenesis. We suggest keyhole resection
of the residual cyst wall as an effective and mini-invasive treatment option.
Keywords
shunt dependency syndrome - cyst-peritoneal shunt - arachnoid cyst - children
