Treatment of hydrocephalus secondary to cryptococcal meningitis by use of shunting

Hydrocephalus can be associated with increased morbidity and mortality in c ryptococcal meningitis if left untreated. Both ventriculoperitoneal and ven triculoatrial shunting have been used in persons with cryptococcosis compli cated by hydrocephalus, but the indications for and complications, success, and timing of these interventions are not well known. To this end, we revi ewed the clinical courses of 10 non-human immunodeficiency virus-infected p atients with hydrocephalus secondary to cryptococcal meningitis who underwe nt shunting procedures, Nine of 10 patients who underwent shunting had noti ceable improvement in dementia and gait. Two patients required late revisio n of their shunts. Shunt placement in eight patients with acute infection d id not disseminate cryptococcal infection into the peritoneum or bloodstrea m, nor did shunting provide a nidus from which Cryptococcus organisms prove d difficult to eradicate. Shunting procedures are a safe and effective ther apy for hydrocephalus in patients with cryptococcal meningitis and need not be delayed until patients are mycologically cured.