Ascites production and prognosis after ventriculoperitoneal shunt for diffuse midline gliomas in children: A case series

DMG is a highly invasive and lethal type of brain tumor. As these tumors progress, they often compromise the CSF circulation, leading to hydrocephalus. Ventriculoperitoneal shunt (VPS) is commonly employed to manage hydrocephalus; however, the complication of VPS-induced ascites, particularly in the presence of tumor cells, is a significant concern that merits attention. This case series details 3 pediatric patients diagnosed with brainstem DMG harboring the H3 K27M mutation. Each developed hydrocephalus underwent VPS insertion. Post-operatively, all patients developed carcinomatous ascites with tumor cells detected within the ascitic fluid. All 3 patients were diagnosed with intra-abdominal metastasis of DMG H3K27M mutant cancer cells, each presenting with distinct complications. Initially, the patients' primary head tumors responded to treatment, and their hydrocephalus resolved. However, some time after discharge, each patient developed malignant ascites and received palliative chemotherapy to control symptoms and improve quality of life. Despite the interventions, all 3 patients died within 1 month of developing malignant ascites, with central respiratory failure being the direct cause of death. These cases underscore the importance of continuous monitoring of both the CSF and ascitic fluid in patients with gliomas. Regular assessments of biochemical composition, cytology, and other diagnostic tests are crucial for early detection of disease progression. This proactive approach facilitates timely clinical judgment and intervention, potentially improving patient outcomes.