The role of lumbar shunts in the management of slit ventricles: does the slit-ventricle syndrome exist?
OBJECTIVE
Slit-ventricle syndrome (SVS) is a confusing description of presentations in patients with chronic shunt-treated hydrocephalus. These patients are prone to acute deterioration with recurrent malfunction. The authors describe the clinical profile and management outcome of using lumboperitoneal (LP) shunts in this population of patients.


METHODS
Thirty-three patients with slit ventricles and recurrent malfunctions were converted to LP shunts (mean age 12 years). The initial ventricular shunt was placed at a mean age of 16.5 months. Ten patients had failed endoscopic third ventriculostomies prior to placement of their LP shunt. At a previous presentation, in 11 patients suspected to have SVS following revision of the shunt, intracranial pressure normalized after insertion of a contralateral shunt, suggesting that their ventricles were isolated. The rate of infection and malfunction was compared before and after conversion to an LP shunt. Twenty-seven patients were successfully converted to LP shunts. Four of the 11 patients with isolated ventricles required ventricular shunts in addition to the LP shunt. During a mean follow-up period of 16.7 months, the malfunction rate per patient decreased from 4.81 for ventriculoperitoneal shunts, prior to conversion to 1.48 after conversion to LP shunts, a statistically significant reduction (p < 0.000). No significant difference was found in the rate of shunt infections (7.1% for VP shunts and 9.6% for LP shunts, p = 0.44). No patient presented with acute symptoms following malfunction of an LP shunt or suffered from a Chiari I malformation.


CONCLUSIONS
Conversion to an LP shunt is a safe and effective procedure in patients prone to rapid decompensation and recurrent shunt malfunctions from small, slitlike ventricles. The term SVS is confusing. The condition is a manifestation of an unrecognized slitlike isolated ventricle and should be abandoned.
Sood
Sandeep
S
Department of Pediatric Neurosurgery, Children's Hospital of Michigan, Wayne State University, Detroit 48201, USA. ssood@med.wayne.edu
Barrett
Ryan J
RJ
Powell
Tiffany
T
Ham
Steven D
SD
D000293:Adolescent; D000328:Adult; D001927:Brain Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D002552:Cerebral Ventricles; D014695:Cerebral Ventriculography; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D012086:Reoperation; D009626:Terminology as Topic; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects