This is followed by ventricular expansion, unblocking the shunt and relieving the clinical symptoms. The patient will present with cycles of shunt malfunction-when the ventricles are very small, they block the shunt. Slit ventricle syndrome is thought to occur from chronic overdrainage and results in noncompliant ventricles. With continued brain growth within the now-restricted cranium, increased ICP recurs with potentially devastating consequences.Īlfredo Quiñones-Hinojosa MD, in Schmidek and Sweet: Operative Neurosurgical Techniques, 2022 Slit Ventricle Syndrome Excessive intracranial decompression may result in cranial vault collapse with secondary craniosynostosis. Additional radiographic findings include a “copper-beaten” appearance or “thumb printing” and scalloping of the inner calvarial table ( Fig. Slit ventricle syndrome is recognized as a triad of chronic, intermittent headaches accompanying findings of a slowly refilling shunt reservoir on physical examination and “slit” ventricles on radiographic evaluation. These patients usually have had a shunt in place for years with overdrainage of cerebrospinal fluid resulting in very small ventricles. Slit ventricle syndrome occurs as a complication in 1% to 5% of patients after shunting procedures for hydrocephalus during infancy and was first described in the 1960s.
SLIT LIKE OPENIN PLUS
Whitaker MD, in Plastic Surgery Secrets Plus (Second Edition), 2010 26 What is “slit ventricle syndrome”? 199-2) suggests that a pressure differential and a higher than normal brain compliance could be the cause of the slit ventricles. However, the observation of the sudden conversion of slit ventricles into large ventricles with progressive increase in opening pressure or after reduction of subarachnoid volume and pressure via lumbar puncture (LP) ( Fig. These patients with small ventricles and high pressures have similarities to those with SVS. In IIH, the high venous pressures may reduce compliance. However, in the case of cerebral hypotension, the vascular engorgement is compensatory and associated with a sagging, and not a stiffer, brain. 98 Increased vascular engorgement is seen intracranial hypotension 97,99,100 as caused by other origins of CSF leak. 97 Vascular engorgement may be a mechanism of decreased brain compliance. 76 However, the ependymal or glial scarring purported to develop in the setting of chronic hydrocephalus that resisted ventricular expansion was not substantiated by pathology studies. The tendency of ventricles to remain small in SVS despite elevated pressures has been considered evidence of reduced compliance. It is important to note that headaches may be associated with high pressures even as the ventricles remain small. 95,96 The etiology of the pain that is described may be low or high pressure. Although chronic low pressure and volume are likely involved, the intraventricular pulse amplitude hypothesized to maintain ventricular size may also be reduced by the pressure regulation of the shunt.
The general etiology of SVS is chronic, nonphysiologic CSF drainage. 94 Because this group of patients is at high risk for morbidity and even mortality, the diagnosis should be sought early and subjective complaints should not be disregarded despite stable imaging. In one estimate, ventricular enlargement may not be evident in at least 20% of patients. 93 Young adults, asymptomatic as children, may present with progressive headaches or proximal occlusions requiring surgery. The pediatric literature has estimated that small ventricles exist in as many as 60% of shunted children, only 10% of whom have symptoms. 93Ĭhildren with chronic overdrainage may do well for many years as their ventricles collapse. Intermittent headaches, small ventricles, and a slowly filling reservoir have been termed the slit ventricle triad. In addition, the reservoir refill may be slow. SVS may be defined as the development of intermittent headaches, usually lasting 10 to 30 minutes, in a shunted patient with smaller than usual ventricles. The effect of chronic, unremitting, CSF shunt–induced overdrainage in a growing child has been termed slit ventricle syndrome (SVS) and is associated with episodic headaches. 92 However, the nonphysiologic regulation of CSF diversion has inadvertently led to chronic shunt-induced headaches in many of these patients. The importance of valve-regulated shunts, first used in the 1950s for patients with congenital hydrocephalus, cannot be overstated. Richard Winn MD, in Youmans and Winn Neurological Surgery, 2017 Slit Ventricle Syndrome