Discussion:
Aseptic meningitis following peroperative extravasation of the content
of cystic craniopharyngioma is a well known complication. It is related
to an irritation of the subarachnoid spaces by the cyst fluid. Thus,
facing a cystic craniopharyngioma, a careful aspiration of its content
is recommended before any further manipulation of the walls. Spontaneous
rupture of craniopharyngioma cyst after VP shunting is a very uncommon
situation, as we have not found any similar reports within the
literature (2,5,6).
The patient described here had meningismus and abdominal distension due
to ascites with both peritoneal and cerebrospinal fluids. This indicates
that he had aseptic meningitis due to the leak of the cystic content of
the craniopharyngioma, which passed through the VP shunt into the
abdominal cavity causing a peritoneal irritation and a reactive ascites.
The presumed explanation for this inadvertence is that the intracranial
hypotension induced by the onset of the VP shunt, created a pressure
gradient between the ventricules and the cyst. Thus, the liquid passed
through tumor capsule and anterior wall of third ventricle, then to the
peritoneal cavity through the abdominal catheter of the VP shunt.
Clinical improvement and disappear of the abdominal collection are
presumably due to cessation of discharge of the cystic contents of the
craniopharyngioma.