Giant Craniopharyngioma Complicated by Cerebrospinal Fluid Ascites in a 7-Year-Old Boy: A Case Report and Review of Literature

Craniopharyngioma (CPG) is a rare benign brain tumor often affecting the sellar/parasellar region in children. Giant variants can cause severe intracranial pressure and hydrocephalus and require ventriculoperitoneal (VP) shunting. A seven-year-old boy presented with a two-year history of headaches, as well as recent visual deterioration, altered sensorium, and vomiting. MRI brain revealed a cystic mass in the sellar and suprasellar regions causing mild hydrocephalus. After tumor excision and VP shunt placement, he developed abdominal CSF ascites, requiring shunt revisions, including ventriculoatrial shunt, and later suffered from a pseudomonas infection, leading to death from acute respiratory distress syndrome and hospital-acquired pneumonia. This case highlights the rare but critical complication of CSF ascites following VP shunting in a child with giant craniopharyngioma, emphasizing the importance of early recognition and timely intervention. Clinicians should be aware of this potential complication, as it requires careful diagnostic workup and management strategies, including shunt modifications and consideration of alternative shunting options.