Ventricular shunt removal: the ultimate treatment of the slit ventricle syndrome

Baskin, Jonathan J.; Manwaring, Kim H.; Rekate, Harold L.

doi:10.3171/jns.1998.88.3.0478

Cited by 157 publications

(87 citation statements)

References 29 publications

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“…TV has been considered as an important strategy in the resolution of slit ventricle syndrome [10, 11], however, it has never been discussed as a treatment option for shunt-induced SDH. In these 2 patients with significant disturbance of consciousness, external ventricular drainage revealed the necessity for low-pressure drainage for clinical improvement.…”

Section: Discussionmentioning

confidence: 99%

Critical Shunt-Induced Subdural Hematoma Treated with Combined Pressure-Programmable Valve Implantation and Endoscopic Third Ventriculostomy

Fukuhara

Vorster

Luciano³

2000

Pediatr Neurosurg

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The authors present 2 patients with VP shunt-induced subdural hematomas (SDH) treated with pressure-programmable valve implantation and endoscopic third ventriculostomies (TV). The first patient is an 11-year-old girl who developed a shunt-induced SDH. Revision of the shunt valve with a higher-pressure valve resulted in a prolonged deterioration of her consciousness. External ventricular drainage at low pressure led to clinical improvement. A pressure-programmable valve set at 50 mm H₂O was implanted, and the pressure gradually increased. At a pressure of 120 mm H₂O symptoms recurred, even though the subdural collection was beginning to decrease in size. An endoscopic TV was performed, and the valve pressure was then increased to 200 mm H₂O without any neurological symptoms. The second patient, a 7-year-old boy with shunt-induced SDH, had recurrent SDH, even after shunt revision with placement of a higher-pressure valve, which resulted in prolonged lethargy. A pressure-programmable valve was implanted with concurrent endoscopic TV. Gradual valve pressure increases up to 200 mm H₂O could be performed without recurrent symptoms. Eventually, the shunt system was ligated to resolve residual positional headache, and the TV has been patent for more than 3 years. In both patients, the pressure-programmable valve was useful, since the optimal CSF drainage pressure changed during the period of recovery from symptomatic subdural collections. Concurrent TV appeared to enable increasing the valve pressure gradually without any neurological symptoms. The advantages of this combined approach are discussed.

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Section: Discussionmentioning

confidence: 99%

Critical Shunt-Induced Subdural Hematoma Treated with Combined Pressure-Programmable Valve Implantation and Endoscopic Third Ventriculostomy

Fukuhara

Vorster

Luciano³

2000

Pediatr Neurosurg

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“…1 This observation by Professor Epstein was indeed true, but we had not recognized it as a criterion for ETV before his comments. In that paper 80% of patients whose ventricles had expanded at the time of shunt removal and clamping of the EVD and who did not have hydrocephalus related to spina bifida underwent successful ETV and were rendered shunt free.…”

Section: Selecting Patients For Etvmentioning

confidence: 98%

The importance of the cortical subarachnoid space in understanding hydrocephalus

Rekate

Nadkarni

Wallace

2008

PED

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Object In this paper the authors define the role of the cortical subarachnoid space (CSAS) in poorly understood forms of hydrocephalus to cerebrospinal fluid (CSF) dynamics to improve understanding of the importance of the CSAS and its role in selecting patients for endoscopic third ventriculostomy (ETV). The secondary purpose of this work was to define testable hypotheses to explain enigmatic disorders of CSF dynamics and to suggest how these concepts could be tested. Methods The magnitude of the contribution of the CSAS is explored using the solid geometry of concentric spheres. With this starting point, clinical conditions in which CSF dynamics are not easily understood are explored regarding the potential role of the CSAS. Overall, problems of CSF dynamics are easily understood. Insights may be gained when the results of a pathological process or its treatment vary from what has been expected. Results Acute changes in ventricular volume at the time that hydrocephalus develops, the failure of shunts, and the changes in ventricular volume with shunt repair may occur very rapidly. Changes in the volume of water in the brain, especially in the brain substance itself, are unlikely to occur at this rapid rate and may be interpreted as a simple redistribution of the CSF between the ventricle and CSAS with no initial change in the actual volume of brain parenchyma. Problems such as pseudotumor cerebri, shunt failure with nonresponsive ventricles, and negative-pressure hydrocephalus can be explained by assessing the ability of ventricular CSF to flow to the CSAS and the ability of this fluid to exit this compartment. Ventricular enlargement at the time of shunt failure implies a failure of flow between the ventricles and CSAS, implying that all patients who show this phenomenon are potential candidates for ETV. Conclusions The important role of the CSAS in the pathophysiology of various forms of hydrocephalus has been largely ignored. Attention to the dynamics of the CSF in this compartment will improve understanding of enigmatic conditions of hydrocephalus and improve selection criteria for treatment paradigms such as ETV. These concepts lead to clearly defined problems that may be solved by the creation of a central database to address these issues.

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“…They also conceded the possibility of a tendency to hindbrain herniation, resulting from an LP shunt especially in patients with Chiari malformation. Recently, some successful trials reported methods to avoid this risk of herniation and other shunt complications, such as endoscopic third ventriculostomy, gradual elevation of intracranial pressure, and valve upgrade [9][10][11] . Although valve upgrade in patients with SVS which develops from PC may improve CSF drainage and improve SVS symptoms, the resultant increased intracranial pressure may have a higher risk of neural injuries and hindbrain herniation from the high intracranial pressure of long duration.…”

Section: Discussionmentioning

confidence: 99%

“…He also suggested appropriate modes of therapy such as medication, shunt removal or revision, valve upgrading, LP shunting, and cranial expansion surgery according to his classification. But there still exists controversy over which mode is the most efficacious since most studies to date have not objectively compared the various methods and only presented successful results of each mode independently [5,[8][9][10][11][19][20][21] . It would seem appropriate to perform cranial expansion surgery, including decompression surgery, in cases where after brain development restriction develops as a result of secondary craniosynostosis after shunting [19,20] .…”

Section: Discussionmentioning

confidence: 99%

“…In particular in a child with SVS, which develops after VP shunting for the treatment of pseudotumor cerebri (PC), the LP shunt is most commonly employed [5,7,8] . However, due to the possible problem of herniation and frequent malfunction with LP shunts in children, it has recently been suggested by some authors that a valve upgrade and third ventriculostomy may also be an efficacious alternative mode of therapy [9][10][11] .…”

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confidence: 99%

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Valve Pressure Upgrade May Produce Progressive Deterioration of Vision in Children with Slit Ventricle Syndrome

Park

Yoon²,

Cho³

et al. 2007

Pediatr Neurosurg

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underwent a lumboperitoneal shunt with low-pressure valve, which resulted in the disappearance of intermittent headaches and a deterioration of visual acuity. We suggest that valve pressure upgrade in children with slit ventricle syndrome after ventriculoperitoneal shunt for pseudotumor cerebri may produce acute deterioration of vision that had already been compromised, even within the normal intracranial pressure range and with improvement of associated symptoms.

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Ventricular shunt removal: the ultimate treatment of the slit ventricle syndrome

Abstract: A significant number of patients debilitated by SVS may experience improvement in their symptoms and undergo shunt removal according to this protocol, improving their quality of life and simplifying their medical follow up.

Cited by 157 publications

References 29 publications

Critical Shunt-Induced Subdural Hematoma Treated with Combined Pressure-Programmable Valve Implantation and Endoscopic Third Ventriculostomy

Critical Shunt-Induced Subdural Hematoma Treated with Combined Pressure-Programmable Valve Implantation and Endoscopic Third Ventriculostomy

The importance of the cortical subarachnoid space in understanding hydrocephalus

Valve Pressure Upgrade May Produce Progressive Deterioration of Vision in Children with Slit Ventricle Syndrome

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