Introduction: Slit ventricle syndrome remains a complex entity presenting a considerable challenge to treat successfully. This study aims to demonstrate the application of dual intracranial pressure (ICP) and infusion studies together with the novel shunt occlusion test in both a diagnostic and therapeutic role. Case Report: An 8-year-old child had aqueduct stenosis treated with a ventriculoperitoneal shunt (medium-pressure valve). The presentation was of headaches with papilloedema. Imaging with both computed tomography and magnetic resonance imaging revealed slit ventricles. Initially a shunt exploration revealed distal obstruction that was treated together with insertion of a paediatric strata II regular valve; however, the child continued to deteriorate. Overnight ICP monitoring revealed dramatically raised ICP with poor compensatory reserve. Intra-operative infusion study revealed a shunt that was patent distally but with proximal obstruction. A subtemporal decompression ipsilateral to the shunt was performed together with adjustment of the paediatric strata II regular valve to 2.5 in order to prevent overdrainage. This led to normalisation of ICP, resolution of papilloedema and symptomatic improvement. Discussion: We demonstrate how combined ICP monitoring and shunt infusion studies can be used to help guide management. Unilateral subtemporal decompressions and preventing shunt overdrainage can result in normalisation of ICP and cerebrospinal fluid dynamics.

Keywords:
Camino intracranial pressure monitor, Strata II regular valve, Subtemporal decompression, Papilloedema, ICM+ software
1.
Olson S: The problematic slit ventricle syndrome: a review of the literature and proposed algorithm for treatment. Pediatr Neurosurg 2004;40:264-269.
2.
Rekate HL: The slit ventricle syndrome: advances based on technology and understanding. Pediatr Neurosurg 2004;40:259-263.
3.
Smielewski P, Czosnyka M, Steiner L, Belestri M, Piechnik S, Pickard JD: ICM+: Software for on-line analysis of bedside monitoring data after severe head trauma. Acta Neurochir Suppl 2005;95:43-49.
4.
Czosnyka Z, Czosnyka M, Owler B, Momjian S, Kasprowicz M, Schmidt EA, et al: Clinical testing of CSF circulation in hydrocephalus. Acta Neurochir Suppl 2005;95:247-251.
5.
Petrella G, Czosynka M, Keong N, Pickard JD, Czosnyka Z: How does CSF dynamics change after shunting? Acta Neurol Scand 2008;118:182-188.
6.
Buxton N, Punt J: Subtemporal decompression: the treatment of noncompliant ventricle syndrome. Neurosurgery 1999;44:513-519.
7.
Linder M, Diehl J, Sklar FH: Subtemporal decompressions for shunt dependent ventricles: mechanism of action. Surg Neurol 1983;19:520-523.
8.
Obana WG, Raskin NH, Cogen PH, Szymanski JA, Edwards MS: Antimigraine treatment for slit ventricle syndrome. Neurosurgery 1990;27:760-763.
9.
Epstein F, Lapras C, Wisoff JH: ‘Slit-ventricle syndrome': etiology and treatment. Pediatr Neurosci 1988;14:5-10.
10.
Foltz EL: Hydrocephalus: the value of treatment. South Med J 1968;61:443.
11.
Goldstein I, LaMarca V, Abbott R, Jallo GI: Slit ventricle syndrome: overview of patho-physiology and treatment. Internet J Neurosurg 2001;1:article 2.
12.
Pudenz RH, Folta EL: Hydrocephalus: overdrainage by ventricular shunts - a review and recommendations. Surg Neurol 1991;35:200-212.
13.
Oi S, Matsumoto S: Infantile hydrocephalus and the slit ventricle syndrome in early infancy. Childs Nerv Syst 1987;3:145-150.
14.
Sood S, Kumar CR, Jamous M, Schuhmann MU, Ham SD, Canady AI: Pathophysiological changes in cerebrovascular distensibility in patients undergoing chronic shunt therapy. J Neurosurg 2004;100(5 supply pediatrics): 447-453.
15.
Rekate HL: Classification of slit-ventricle syndromes using intracranial pressure monitoring. Pediatr Neurosurg 1993;19:15-20.
16.
Schuhmann MU, Sood S, McAllister JP, Jaeger M, Ham SD, Czosnyka Z, Czosnyka M: Value of overnight monitoring of intracranial pressure in hydrocephalic children. Pediatr Neurosurg 2008;44:269-279.
© 2014 S. Karger AG, Basel
2014
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