Ventriculoperitoneal shunt in the treatment of cryptococcal meningitis with intracranial hypertension

Cryptococcal meningitis (CM) combined with intracranial hypertension is associated with a poor prognosis. This study aimed to investigate the therapeutic efficacy and prognostic factors of ventriculoperitoneal (VP) shunt in non-human immunodeficiency virus (HIV) CM patients with intracranial hypertension. A total of 136 non-HIV CM patients with intracranial hypertension treated in our hospital from July 2010 to December 2019 were retrospectively included. 57 patients underwent VP shunt placement (shunt group) and 79 patients received conservative therapy (conservative group). The clinical symptoms after treatment, cerebrospinal fluid (CSF) test results, and therapeutic outcomes were compared between the groups. VP shunt significantly reduced the incidences of headache, vomiting, cranial nerve injury, intracranial pressure, and CSF leukocyte level in CM patients (all p < 0.05). The shunt group had a significantly higher curative rate, shorter seroconversion time, hospitalization time, and disease duration (all p < 0.001). However, no significant difference in the survival outcome was observed between the groups (p = 0.163). Cox proportional-hazard regression analysis showed that seroconversion time was the only independent factor associated with the survival outcome. Our results suggested that the VP shunt is an effective and safe treatment for non-HIV CM patients combined with intracranial hypertension. Seroconversion time was the only independent factor associated with the survival outcome.