The Slit-Ventricle Syndrome After Shunting in Hydrocephalic Children

Abstract

Obstruction and infection are usually considered the most frequent complications in shunt procedures of infant hydrocephalus.

There are, however, numerous complications by overdrainage of cerebrospinal fluid with the potential of collapse of ventricular cavities; computerized tomography in these situations reveals slit-like ventricles (SLV). This ventricular collapse may cause an intermittent shunt obstruction. According to the different authors, either overdrainage decompression symptoms or increased intracranial pressure by shunt obstruction are emphasized.

This study was to evaluate the frequency and clinical manifestations of overdrainage in 302 hydrocephalus patients, seen in the hydrocephalus and spina bifida outpatient clinic of the Division of Neuro-Pediatrics, University Children's-Hospital Düsseldorf, from July 1 to December 31,1979.

The frequency of the slit-ventricle-syndrome (5.3%) was about equal to shunt revisions because of obstruction with dilatation of ventricular cavities demonstrated in computerized tomography (6.6%). In only 3 patients the slit-like-ventricle occurred after shunt revisions. There were no infants, probably because of the use of medium-pressure valves. In most of the cases the diagnosis was made by clinical manifestations of decompression. According to the stage of slit-ventricle syndrome (SVS) primary symptoms of decompression and secondary signs of increased intracranial pressure may arise, however, one after another or in alternation in the same patient. Although the frequency of subdural hematomas is up to 21 % according to the literature, there was no case of this complication of acute decompression in our patients. Microcephalus following chronic decompression was only seen in one of our SLV-children.

Clinical manifestations of decompression, shunt findings and computerized tomography are critically analysed as diagnostic criteria. Because of a still lacking individually adjustable shunt system, a useful diagnostic and therapeutic approach to SVS, based on the experiences of this study, is explained.

Key words

Hydrocephalus - Slit-ventricle syndrome (SVS) - Slit-like-ventricle (SLV) - Children