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.