{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:08:14Z","timestamp":1790014094096,"version":"4.0.1"},"reference-count":41,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2016,7]]},"abstract":"\nOBJECT<\/jats:title>\nPatients with cryptococcal meningitis often develop symptomatic intracranial hypertension. The need for permanent CSF diversion in these cases remains unclear.<\/jats:p><\/jats:sec>\n\nMETHODS<\/jats:title>\nCases of cryptococcal meningitis over a 5-year period were reviewed from a single, large teaching hospital. Sources of identification included ICD-9 codes, operative logs, and microscopy laboratory records.<\/jats:p><\/jats:sec>\n\nRESULTS<\/jats:title>\nFifty cases of cryptococcal meningitis were identified. Ninety-eight percent (49\/50) of patients were HIV positive. Opening pressure on initial lumbar puncture diagnosing cryptococcal meningitis was elevated (> 25 cm H2<\/jats:sub>O) in 33 cases and normal (\u2264 25 cm H2<\/jats:sub>O) in 17 cases. Thirty-eight patients ultimately developed elevated opening pressure over a follow-up period ranging from weeks to years.<\/jats:p>\nSerial lumbar punctures for relief of intracranial hypertension were performed in 29 cases. Thirteen of these patients ultimately had shunting procedures performed after failing to improve clinically. Two factors were significantly associated with the need for shunting: patients undergoing shunt placement were more likely to be women (5\/13 vs 0\/16; p = 0.01) and to have a pattern of increasing CSF cryptococcal antigen (10\/13 vs 3\/16 cases; p = 0.003). All patients re-presenting with mycological relapse either underwent or were offered shunt placement.<\/jats:p><\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nNeurosurgeons are often asked to consider CSF diversion in cases of cryptococcal meningitis complicated by intracranial hypertension. Most patients do well with serial lumbar punctures combined with antifungal therapy. When required, shunting generally provided sustained relief from intracranial hypertension symptoms. Ventriculoperitoneal shunts are the favored method of diversion. To the authors\u2019 knowledge, the present study is the largest series on diversionary shunts in primarily HIV-positive patients with this problem.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.4.jns15255","type":"journal-article","created":{"date-parts":[[2015,10,30]],"date-time":"2015-10-30T14:03:06Z","timestamp":1446213786000},"page":"177-186","source":"Crossref","is-referenced-by-count":40,"title":["Shunting in cryptococcal meningitis"],"prefix":"10.3171","volume":"125","author":[{"given":"Jacob","family":"Cherian","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Atmar","sequence":"additional","affiliation":[{"name":"Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shankar P.","family":"Gopinath","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns15255","series-title":"Clin Infect Dis","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1086\/317432","article-title":"The role of lumbar puncture in the management of elevated intracranial pressure in patients with AIDS-associated cryptococcal meningitis","volume":"31","author":"Antinori","year":"2000"},{"key":"b2-jns15255","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1280","DOI":"10.1097\/00006123-199712000-00008","article-title":"Use of cerebrospinal fluid shunts in patients having acquired immunodeficiency syndrome with cryptococcal meningitis and uncontrollable intracranial hypertension","volume":"41","author":"Bach","year":"1997"},{"key":"b3-jns15255","series-title":"East Afr Med J","first-page":"145","article-title":"Mortality after clinical management of AIDS-associated cryptococcal meningitis in Kenya","volume":"91","author":"Baldassarre","year":"2014"},{"key":"b4-jns15255","series-title":"AIDS","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1097\/QAD.0b013e32832605fe","article-title":"Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures","volume":"23","author":"Bicanic","year":"2009"},{"key":"b5-jns15255","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1080\/02688690310001611242","article-title":"Surgical treatment of intracranial hypertension in encephalic cryptococcosis","volume":"17","author":"Calvo","year":"2003"},{"key":"b6-jns15255","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1227\/00006123-198907000-00008","article-title":"Neurosurgical aspects of cerebral cryptococcosis","volume":"25","author":"Chan","year":"1989"},{"key":"b7-jns15255","series-title":"Mycoses","doi-asserted-by":"publisher","first-page":"e178","DOI":"10.1111\/j.1439-0507.2010.01870.x","article-title":"Immune reconstitution inflammatory syndrome (IRIS) associated with Cryptococcus neoformans infection in AIDS patients","volume":"54","author":"da Cunha Colombo","year":"2011"},{"key":"b8-jns15255","series-title":"Am J Med","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/0002-9343(91)90126-I","article-title":"Elevated cerebrospinal fluid pressures in patients with cryptococcal meningitis and acquired immunodeficiency syndrome","volume":"91","author":"Denning","year":"1991"},{"key":"b9-jns15255","series-title":"Arch Intern Med","doi-asserted-by":"publisher","first-page":"2301","DOI":"10.1001\/archinte.1989.00390100107024","article-title":"Itraconazole therapy for cryptococcal meningitis and cryptococcosis","volume":"149","author":"Denning","year":"1989"},{"key":"b10-jns15255","series-title":"J Neurol Sci","first-page":"283","article-title":"Cryptococcal meningitis. 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