Slit ventricle syndrome in children: Clinical presentation and treatment

The term "slit ventricle syndrome" (SVS) refers to an episodic occurrence of headache, vomiting, and possibly some degree of consciousness impairment in shunted hydrocephalic children in whom slit-like ventricles are seen on computed tomography (CT) scan or magnetic resonance imaging (MRI). We present six cases of SVS which we have seen at our institute in last 10 years. From 1986 to 1996, 821 patients underwent shunt surgery for hydrocephalus. The etiology of the hydrocephalus included brain tumor (140 patients), posthemorrhagic hydrocephalus (62 patients), idiopathic normotensive hydrocephalus (64 patients), postmeningitic hydrocephalus (58 patients), posttraumatic hydrocephalus (54 patients), congenital hydrocephalus (48 patients), neurocysticercosis (31 patients), and unknown (364 patients). During the mean follow-up period of 68 months, shunt revision was performed on 232 cases, yielding a revision rate of 1.28 per patient. The incidence of SVS was 0.7% (6 cases). Most of the patients had been operated on in infancy. The time from the first operation to the development of slit ventricle syndrome ranged from 4 to 8 years; the mean was 6 years. Shuntograms showed patent shunts in all patients. Two patients with less severe clinical symptoms improved with conservative treatment. Intracranial pressure (ICP) was not measured in these patients because of a good hospital course. One patient showed high ICP and needed only revision with the same pressure valve as in the previous shunt. Low ICP was noted in three patients. Pressure augmentation using an antisiphon device or an upgrading valve system were necessary in these patients. The authors stress that determining the type of SVS is the first step in treatment, and that the best treatment is a strategy aimed at resolving the specific type of SVS responsible for the symptoms.