Shunt treatment for coccidioidomycosis-related hydrocephalus: a single center series.

Shunt treatment for coccidioidomycosis-related hydrocephalus: a single center series.:

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Shunt treatment for coccidioidomycosis-related hydrocephalus: a single center series.

World Neurosurg. 2020 Apr 02;:

Authors: Morshed RA, Lee AT, Egladyous A, Avalos LN, Aghi MK, Theodosopoulos PV, McDermott MW, Hervey-Jumper SL

Abstract

OBJECTIVE: Coccidioidomycosis is a fungal infection endemic to the southwestern United States. Hydrocephalus can develop after intracranial dissemination, and management of this disease entity is difficult. We present our institutional experience with shunting coccidioidomycosis-related hydrocephalus.

METHODS: A cohort of patients with coccidioidomycosis-related hydrocephalus undergoing an intracranial shunt placement were retrospectively identified over a 24-year period. Demographics and treatment characteristics were obtained from the electronic medical record.

RESULTS: 30 patients undergoing 83 procedures were identified with a median follow-up of 19.4 months. The average age of the cohort was 43 years at the time of initial shunt placement. Most patients (66.7%) had a least 1 shunt failure, and the average number of revisions required was 2.6 for patients who suffered from shunt failure. The average shunt valve pressure threshold required was 5.5 cm H2O, and patients who harbored the disease for a longer period of time (> 7 months) had a lower pressure setting for initial shunt valves. Shunts without an anti-siphon component were much more likely to be failure-free on multivariate analysis (OR 9.2; 95%CI [2.4 - 35.7]). Death was associated with a longer diagnosis-to-shunt time interval, and patients having been diagnosed with intracranial disease for more than 10 months prior to shunt placement had significantly higher rates of death on follow-up.

CONCLUSIONS: Patients with coccidioidomycosis-related hydrocephalus typically have normal to low pressure setting requirements, high shunt failure rates, prolonged hospitalizations, and mortality. In this disease context, shunt valves without an anti-siphon component are associated with lower shunt failure rates.

PMID: 32247798 [PubMed - as supplied by publisher]