CHILDHOOD OPTIC PATHWAY TUMORS ASSOCIATED WITH ASCITES FOLLOWING VENTRICULOPERITONEAL SHUNT PLACEMENT

Three children with optic pathway gliomas who developed ascites follow ing 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 fol lowing placement of the ventriculoperitoneal shunt, none of the patien ts had evidence of infection or tumor seeding in the peritoneal cavity . The ascites completely resolved in each instance after converting th e shunt to a ventriculoatrial system. Ascites following ventriculoperi toneal shunt insertion is an uncommon complication. A review of the li terature and discussion of the possible etiologic factors in the devel opment of ascites after ventriculoperitoneal shunt placement are prese nted. For patients diagnosed with optic gliomas, it is suggested that because the tumor is widely exposed to the CSF space, protein exuded b y the mass into the subarachnoid space will cause an elevated CSF prot ein concentration. The elevated CSF protein may then lead to ascites a s a result of poor absorption of CSF in the peritoneal cavity after pl acement of a ventriculoperitoneal shunt. Although ascites following ve ntriculoperitoneal shunt placement is not typical in patients with opt ic gliomas, attention should be given to CSF protein levels documented at the time of CSF diversion for hydrocephalus, recognizing that asci tes may occur as a result of poor CSF absorption in the periotoneum, s ubsequently requiring a ventriculoatrial shunt in patients who develop hydrocephalus.