title: Combined intracranial pressure monitoring and cerebrospinal fluid infusion study to guide management of slit ventricle syndrome.
abstract: BACKGROUND
  Slit ventricle syndrome remains a complex entity presenting a considerable challenge to treat successfully. This study aims to demonstrate the application of dual intracranial pressure (ICP) and infusion studies together with the novel shunt occlusion test in both a diagnostic and therapeutic role.
  
  
  METHODS
  An 8-year-old child had aqueduct stenosis treated with a ventriculoperitoneal shunt (medium-pressure valve). The presentation was of headaches with papilloedema. Imaging with both computed tomography and magnetic resonance imaging revealed slit ventricles. Initially a shunt exploration revealed distal obstruction that was treated together with insertion of a paediatric strata II regular valve; however, the child continued to deteriorate. Overnight ICP monitoring revealed dramatically raised ICP with poor compensatory reserve. Intra-operative infusion study revealed a shunt that was patent distally but with proximal obstruction. A subtemporal decompression ipsilateral to the shunt was performed together with adjustment of the paediatric strata II regular valve to 2.5 in order to prevent overdrainage. This led to normalisation of ICP, resolution of papilloedema and symptomatic improvement.
  
  
  CONCLUSIONS
  We demonstrate how combined ICP monitoring and shunt infusion studies can be used to help guide management. Unilateral subtemporal decompressions and preventing shunt overdrainage can result in normalisation of ICP and cerebrospinal fluid dynamics.
authors: Academic Division of Neurosurgery, Departments of Clinical Neurosciences and Neurosurgery, Addenbrooke's Hospital, Cambridge, UK.
authors: Michael Gavin
authors: MG
authors: Hart
authors: Marek
authors: M
authors: Czosnyka
authors: Zofia Helena
authors: ZH
authors: Czosnyka
authors: Helen Marie
authors: HM
authors: Fernandes
mesh_terms: D002648:Child; D019468:Disease Management; D006801:Humans; D007260:Infusion Pumps; D007427:Intracranial Pressure / Q000502:physiology*; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D056124:Slit Ventricle Syndrome / Q000175:diagnosis / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*