The Problematic Slit Ventricle Syndrome

Abstract

This review discusses the clinical difficulties with the so-called slit ventricle syndrome. It discusses why this terminology makes it difficult to formulate treatment algorithms. Slit ventricle syndrome should probably be known as the non-compliant ventricle syndrome to avoid confusion of radiological ‘slit ventricles’ with the syndrome. Therapeutic measures should ideally focus on the underlying pathology related to the syndrome. For those patients with iatrogenic small calvaria and synostosis, subtemporal decompression would appear a low-risk and quick procedure. Calvarial expansion would be a second-line treatment. For those patients with a normal-sized calvarium and non-compliant ventricle syndrome, valve upgrade, adding an antisiphon device or programmable valve would appear a good first step. For patients in whom the diagnosis is unclear, a potential management plan is discussed.

Changes in intracranial venous hemodynamics in a patient with idiopathic intracranial hypertension after lumbar puncture precedes therapeutic success

“…Persistence of dural venous sinus stenosis after normalization of CSF pressure in patients with long-lasting IIH might be due to the vessel walls becoming rigid. 10 SSS MRI flow measurements with calculation of the hemodynamic parameters, however, showed remarkable differences in the hemodynamic characteristics following LP. As the PI and RI decreased after LP, it can be presumed that the vascular elasticity increased despite persistence of transverse sinus stenoses.…”

Slit ventricle syndrome and early-onset secondary craniosynostosis in an infant

“…However, the background etiology of recurrent shunt failures is frequently unnoticed in clinical practice; slit ventricle syndrome is an example of this. Symptoms of shunt obstruction, slit-like ventricles in imaging studies, and slow filling of the shunt reservoir are the classical triad of slit ventricle syndrome [4]. Nonetheless, the intermittent nature of symptoms, subtle changes in ventricle size, and inexperience of physicians often lead to the misdiagnosis of simple shunt obstruction.…”

“…Overdrainage of CSF can affect the physical characteristics and growth of the brain parenchyma, ventricles, and skull [2]. A decrease in ventricular size and brain compliance occasionally leads to slit ventricle syndrome, a serious complication of long-standing shunts [3,4]. In slit ventricle syndrome, small ventricles and a stiff brain make the shunt malfunction and cause significant headache and other symptoms of increased ICP.…”

Treatment of Cephalocranial Disproportion in Shunt-Induced Slit Ventricle Syndrome with Cranial Vault Distraction Osteogenesis

“…Premature closure of cranial sutures (craniosynostosis) has been related to shunting procedures, leading to cephalocranial disproportion (CCD) [2,3,4]. The surgical treatment of SVS has been divided into three main groups: (1) restoration of CSF circulation or correction of impaired CSF absorbtion (placement of ventricular, lumboperitoneal shunts and third ventriculostomy); (2) modification of previously inserted shunts (removal, programming), and (3) increasing craniocerebral compliance in the presence of CCD (subtemporal craniectomy and cranial vault expansion) [1,2,3]. …”