The application of controlled intracranial hypertension in slit ventricle syndrome patients with obstructive hydrocephalus and shunt malfunction.
When a shunted patient with slit-ventricle syndrome (SVS) presents with a shunt malfunction or infection, the third ventricle may not be of sufficient caliber, despite the shunt malfunction, to allow atraumatic passage of an endoscope to the floor of the third ventricle. We describe four slit ventricle syndrome patients with respectively 24, 12, 18 and 2 prior shunt revisions who presented with shunt infection. In each patient the shunt was externalized and controlled intracranial hypertension (CIH) was applied over an average of 5.8 days by raising the height of the external ventricular drain (EVD) bag to a mean height of 18.8 cm above EAM. This increased the mean transverse third ventricular diameter from an average of 0.28 cm on admission to 1.13 cm after application of CIH. Endoscopic third ventriculocisternostomy (ETV) was satisfactorily performed in three of the four patients who remain shunt free after a mean follow-up of 21.3 months. CIH followed by ETV is an option in selected SVS patients who present with shunt malfunction or infection.
Butler
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Wang Ambulatory Care Service 331, Pediatric Neurosurgery, Massachusetts General Hospital, Fruit Street, Boston, MA 02114, USA. wbutler@bohr.mgh.harvard.edu
Khan
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D000293:Adolescent; D000328:Adult; D002648:Child; D004868:Equipment Failure; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D011425:Propionibacterium acnes / Q000302:isolation & purification; D013203:Staphylococcal Infections / Q000382:microbiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D013577:Syndrome; D020542:Third Ventricle / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014696:Ventriculostomy / Q000295:instrumentation*