Analysis of therapeutic choices for slit ventricle syndrome after cyst-peritoneal shunting for temporal arachnoid cysts in children

Object The goal in this study was to investigate early diagnostic evidence, optimal therapeutic strategies, and prophylactic methods for slit ventricle syndrome (SVS) in patients with temporal lobe arachnoid cysts who received cyst-peritoneal (CP) shunts. Methods Six cases of SVS in patients with temporal lobe arachnoid cysts who received CP shunts were treated by the senior authors in 2 institutions between January 2005 and January 2009. The radiological data, treatment process, and therapeutic results were reviewed retrospectively. Results There were 4 boys and 2 girls, whose mean age at presentation was 4 years and 1 month. The main clinical symptoms were severe headache, nausea, vomiting, and decreasing eyesight. Radiological studies showed normal or slightly smaller than normal ventricles, and arachnoid cysts that had shrunk dramatically. The most effective treatment for SVS was to replace the original shunts with devices that had a programmable valve, or if this was unsuccessful, to replace the original shunts with ventriculoperitoneal (VP) shunts. All symptoms in these patients disappeared, and the mean follow-up duration was 24 months. Conclusions The SVS presents more often in patients with hydrocephalus who undergo VP shunting. However, it is also a serious complication in patients with arachnoid cysts who receive a CP shunt. The SVS is not a single condition; rather, different pathophysiological conditions can underlie this complicated syndrome. Because there are no striking morphological changes on radiological studies of the SVS in the patients with CP shunts, it is not easy for this syndrome to be diagnosed in time and treated rationally. Misdiagnosis and delayed treatment usually occur. The use of programmable shunts or VP shunts to replace the original shunt is an optimal therapeutic choice. The use of low-pressure shunts to treat arachnoid cysts should be abandoned unless dictated by specific indications.

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Erratum: Analysis of therapeutic choices for slit ventricle syndrome after cyst-peritoneal shunting for temporal arachnoid cysts in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.11.peds10222a ◽

2011 ◽

Vol 7 (2) ◽

pp. 220

Author(s):

Jian Xing

Keyword(s):

Arachnoid Cysts ◽

Slit Ventricle Syndrome ◽

Slit Ventricle

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In vitro testing of explanted shunt valves in hydrocephalic patients with suspected valve malfunction

Neurosurgical Review ◽

10.1007/s10143-021-01564-8 ◽

2021 ◽

Author(s):

Christoph Bettag ◽

Christian von der Brelie ◽

Florian Baptist Freimann ◽

Ulrich-Wilhelm Thomale ◽

Veit Rohde ◽

...

Keyword(s):

Flow Rate ◽

Clinical Symptoms ◽

Obstructive Hydrocephalus ◽

Flow Characteristics ◽

Normal Pressure ◽

Diagnostic Tools ◽

Programmable Valve ◽

Significant Difference ◽

Valve Malfunction

AbstractDiagnosis of symptomatic valve malfunction in hydrocephalic patients treated with VP-Shunt (VPS) might be difficult. Clinical symptoms such as headache or nausea are nonspecific, hence cerebrospinal fluid (CSF) over- or underdrainage can only be suspected but not proven. Knowledge concerning valve malfunction is still limited. We aim to provide data on the flow characteristics of explanted shunt valves in patients with suspected valve malfunction. An in vitro shunt laboratory setup was used to analyze the explanted valves under conditions similar to those in an implanted VPS. The differential pressure (DP) of the valve was adjusted stepwise to 20, 10, 6, and 4 cmH2O. The flow rate of the explanted and the regular flow rate of an identical reference valve were evaluated at the respective DPs. Twelve valves of different types (Codman CertasPlus valve n = 3, Miethke Shuntassistant valve n = 4, Codman Hakim programmable valve n = 3, DP component of Miethke proGAV 2.0 valve n = 2) from eight hydrocephalic patients (four male), in whom valve malfunction was assumed between 2016 and 2017, were replaced with a new valve. Four patients suffered from idiopathic normal pressure (iNPH), three patients from malresorptive and one patient from obstructive hydrocephalus. Post-hoc analysis revealed a significant difference (p < 0.001) of the flow rate between each explanted valve and their corresponding reference valve, at each DP. In all patients, significant alterations of flow rates were demonstrated, verifying a valve malfunction, which could not be objectified by the diagnostic tools used in the clinical routine. In cases with obscure clinical VPS insufficiency, valve deficiency should be considered.

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MANAGEMENT OF THE SLIT VENTRICLE SYNDROME

Neurosurgery ◽

10.1227/00006123-198908000-00030 ◽

1989 ◽

Vol 25 (2) ◽

pp. 318

Keyword(s):

Slit Ventricle Syndrome ◽

Slit Ventricle

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Combined Intracranial Pressure Monitoring and Cerebrospinal Fluid Infusion Study to Guide Management of Slit Ventricle Syndrome

Pediatric Neurosurgery ◽

10.1159/000358561 ◽

2013 ◽

Vol 49 (2) ◽

pp. 113-118 ◽

Cited By ~ 2

Author(s):

Michael Gavin Hart ◽

Marek Czosnyka ◽

Zofia Helena Czosnyka ◽

Helen Marie Fernandes

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Intracranial Pressure Monitoring ◽

Pressure Monitoring ◽

Slit Ventricle Syndrome ◽

Fluid Infusion ◽

Infusion Study ◽

Slit Ventricle

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The ultrasonographic assessment of the morphological changes in the ulnar nerve at the cubital tunnel in Japanese volunteers: Relationship between dynamic ulnar nerve instability and clinical symptoms

JSES International ◽

10.1016/j.jseint.2021.05.005 ◽

2021 ◽

Author(s):

Fumitaka Endo ◽

Tsuyoshi Tajika ◽

Takuro Kubo ◽

Satoshi Shinagawa ◽

Toshiki Tsukui ◽

...

Keyword(s):

Ulnar Nerve ◽

Clinical Symptoms ◽

Morphological Changes ◽

Cubital Tunnel ◽

Ultrasonographic Assessment ◽

Ulnar Nerve Instability

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Management of Slit Ventricle Syndrome: A Single-Center case series of 32 surgically treated patients

World Neurosurgery ◽

10.1016/j.wneu.2021.10.183 ◽

2021 ◽

Author(s):

Auricchio Anna Maria ◽

Bohnen Angela ◽

Nichelatti Michele ◽

Cenzato Marco ◽

Talamonti Giuseppe

Keyword(s):

Case Series ◽

Single Center ◽

Slit Ventricle Syndrome ◽

Slit Ventricle

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‘Slit-Ventricle Syndrome’: Etiology and Treatment

Pediatric Neurosurgery ◽

10.1159/000120354 ◽

1988 ◽

Vol 14 (1) ◽

pp. 5-10 ◽

Cited By ~ 88

Author(s):

Fred Epstein ◽

Claude Lapras ◽

Jeffrey H. Wisoff

Keyword(s):

Slit Ventricle Syndrome ◽

Slit Ventricle

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Slit Ventricle Syndrome Presenting with Paroxysmal Hypersomnia in an Adult: Case Report

Neurosurgery ◽

10.1227/00006123-198803000-00028 ◽

1988 ◽

Vol 22 (3) ◽

pp. 594-595 ◽

Cited By ~ 3

Author(s):

Ender Korfali ◽

Kaya Aksoy ◽

Imran Safi

Keyword(s):

Case Report ◽

Intracranial Pressure ◽

Shunt Malfunction ◽

Ventricular Catheter ◽

Ventricular Enlargement ◽

Adult Case ◽

Slit Ventricle Syndrome ◽

Computed Tomographic ◽

Lateral Ventricles ◽

Slit Ventricle

Abstract The slit ventricle syndrome (SVS), defined as intermittent shunt malfunction without substantial ventricular enlargement, is usually observed in shunted children with small, slitlike ventricles. This syndrome has been attributed to recurrent obstruction of the ventricular catheter, which then causes an increase of intracranial pressure. Only rarely has the SVS been reported in adults. We describe a 29-year-old woman whose shunt malfunction presented with longlasting paroxysmal hypersomnia and was diagnosed with computed tomographic evidence of small lateral ventricles. This episodic hypersomnia presented every 2 to 3 weeks and each episode lasted 1 to 2 weeks. After revision of the ventricular catheter, her symptoms stopped and she remained well. (Neurosurgery 22:594-595, 1988)

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