Cerebrospinal fluid ascites after ventriculoperitoneal shunting : a comprehensive systematic review emphasizing patient demographic attributes

Abstract

Introduction An unusual complication of ventriculoperitoneal (VP) shunting is the accumulation of cerebrospinal fluid (CSF) in the peritoneal cavity, resulting in abdominal distention known as CSF ascites. While its impact on the affected individuals' quality of life is significant, knowledge about its demographics and prevalence remains limited. This systematic review aims to systematically assess CSF ascites, prevalence, demographic patterns and contribute to a better understanding of the condition.

Methods A systematic literature review was conducted in six major databases following the PRISMA 2020 checklist. Articles were included following rigorous screening and pre-defined inclusion criteria and exclusion criteria. A standardised data extraction table was used, and descriptive and inferential statistics were conducted using the Jeffreys's Amazing Statistics Program (JASP). The Joanna-Briggs' Institute (JBI) tool was used to assess the quality of reporting.

Results 79 articles were included, 64 articles documented CSF ascites in children (representing 83 cases), with the remainder describing CSF ascites in adults. An overall high quality and transparent reporting by the included articles was noted. In the children, the median age at VP shunt placement was 12 months. Age at shunt placement didn't differ by gender. The most common conditions were optic pathway tumours. Ascites onset after shunt placement took a median of 10 months (IQR: 40.5 months) and wasn't correlated with age at shunt placement. 92.72% achieved ascites resolution with treatment, with 59.04% receiving conversion to a ventriculoatrial (VA) shunt as treatment. n adult patients, the median age at VP shunt placement was 39.00 years, with no significant gender differences in age distribution. The primary condition was mostly normal pressure hydrocephalus (40.00%, N = 15). Ascites onset after shunt placement took a median of 9 months and did not differ by gender. Age at shunt placement and duration between placement and ascites onset were not correlated. Ascites resolved in 84.62% of patients with the most common treatment being VP to VA shunt conversion.

Discussion and conclusion CSF ascites, a rare complication of VP shunting across age groups, have diverse causes. This systematic review clarifies its demographics, showing no clear gender or age-related trends in occurrence. The link between primary conditions and demographics echoes disease patterns. Mortality solely from CSF ascites is rare, and treatment success is high. Converting VP to VA shunts stands out as the preferred solution. While data discrepancies limit demographic analysis, this study significantly advances CSF ascites understanding, warranting more research and clinical attention.