Slit-ventricle syndrome in shunt operated children

Abstract

Chronic intracranial hypotension is considered as a frequent complication in shunted hydrocephalus, besides obstruction and shunt-infections. In the last twenty years 32 cases of slit-ventricle were diagnosed among the more than one thousand operations on hydrocephalic children at the Paediatric Department of the National Institute of Neurosurgery, Budapest, Hungary. Most of them have been operated on in infancy. Time from the first operation to the development of slit-ventricle ranged from one to twelve years, the mean was 6.5 years. Seven patients were symptomless (22%), while 25 patients (78%) had more or less severe slit-ventricle syndrome with headache (25 cases), nausea/vomiting (23 cases), altered consciousness (21 cases), brainstem signs (12 cases), and epileptic fits (2 cases). Ten patients with moderate clinical signs improved under conservative treatment. In 15 cases an anti-siphon device (ASD) was implanted. In five of them the clinical result was good, but in the remaining 10 cases typical hypertensive signs were seen. In these cases low flow rate valves were implanted instead of the middle flow rate valve and ASD. In one case the intracranial hypertension persisted, so a middle flow rate shunt system was "reimplanted" and finally the patient improved. In this study the experiences with these 32 cases will be analysed and discussed. The authors stress the primary use of combined valves to avoid the slit-ventricle syndrome.

Lumbar CSF Shunting Preferentially Drains the Cerebral Subarachnoid over the Ventricular Spaces: Implications for the Treatment of Slit Ventricle Syndrome

“…In 1993, Rekate defi ned SVS as the triad of intermittent headaches lasting 10-30 min, smaller than normal ventricles on imaging, and slow refi ll of the palpable valve [4] . It is generally considered to be a chronic complication, occurring years after the initial shunt procedure with the average time from the fi rst shunt operation to the development of SVS being approximately 6.5 years [5,6] . The incidence of SVS is hard to ascertain from the literature with a range of 1-37% being reported [1,[6][7][8][9][10] .…”

“…It is generally considered to be a chronic complication, occurring years after the initial shunt procedure with the average time from the fi rst shunt operation to the development of SVS being approximately 6.5 years [5,6] . The incidence of SVS is hard to ascertain from the literature with a range of 1-37% being reported [1,[6][7][8][9][10] . More specifi cally, of the 370 patients shunted by Walker et al [11] , 60-80% were reported as developing slit ventricles, whereas only 11.5% developed SVS, and only 6.5% of those patients required surgical intervention.…”

Changes in Intracranial Pressure after Calvarial Expansion Surgery in Children with Slit Ventricle Syndrome

“…The condition may involve different underlying causes and various intracranial pressure (ICP) abnormalities [3, 4]. Depending on the underlying cause, numerous treatment strategies have been advocated, including conservative treatment, shunt revision, shunt removal, third ventriculostomy, antimigrainous therapy, high resistant or antisiphon valves and subtemporal craniectomy (STC) [1, 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13]. …”

Lumboperitoneal Shunting as a Treatment for Slit Ventricle Syndrome

“…Furthermore, only a certain unpredictable subset of these patients goes on to develop SVS. The true incidence of SVS in shunted patients is difficult to determine from the literature but has been reported to be between 1 and 37% [4, 5, 6, 7, 8]. …”

“…Conservative management includes observation, intravenous hydration therapy, diuretics, dexamethasone and antimigraine treatment [4, 7, 8]. Initial surgical treatment for SVS is usually a shunt revision of one kind or another.…”