Slit Ventricle as a Neurosurgical Emergency

Case Report and Review of Literature

Zoltan Mencser, Zsolt Kopniczky, David Kis, P. Barzó

Research output: Contribution to journalArticle

Abstract

Background: Symptomatic slit ventricle is one of the most challenging complications of shunt surgery in children. Clinical signs and symptoms may appear with a wide range of intracranial pressure (ICP) values. We report the case of a 10-year-old girl, who did not present the classic clinical features of extremely elevated ICP, which was proven by multiple invasive ICP recordings, performed during shunt revisions. Case Description: At the age of 6 months, the patient presented squeal for many hours, accompanied with sunset eyes, bulging anterior fontanel, and dilated ventricles of all 4 ventricles on computed tomography scan. Acute ventriculoperitoneal shunt insertion was performed with adjustable valve. During the following 9 years, she was regularly seen and medically treated for intermittent headache, with nausea and vomiting. From 9 years of age, she was hospitalized for severe (10/10 on the visual analog scale), unbearable headache, agitation, and screaming on multiple occasions. Altogether, we had to revise the shunt system 5 times throughout 1 year. Radiologic imaging always showed narrow ventricles. Ophthalmologic examination of the fundus never revealed signs of raised ICP. Perioperative monitoring of the ICP with intraparenchymal sensor showed unexpected high values of 40–45 mm Hg. However, repetitive shunt revisions were successful only temporarily because the symptoms always returned. Only bilateral shunting of the ventricular system was able to eliminate the symptoms permanently. Conclusions: Images of slit ventricle can be associated either with low or extremely high ICP needing urgent surgical consideration, including ICP monitoring. Bilateral shunt insertion can be effective treatment for slit ventricle syndrome.

Original languageEnglish
Pages (from-to)493-498
Number of pages6
JournalWorld Neurosurgery
Volume130
DOIs
Publication statusPublished - Oct 1 2019

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Intracranial Pressure
Emergencies
Slit Ventricle Syndrome
Headache
Cranial Fontanelles
Ventriculoperitoneal Shunt
Intracranial Hypertension
Visual Analog Scale
Nausea
Signs and Symptoms
Vomiting
Tomography

Keywords

  • Hydrocephalus
  • Raised ICP
  • Shunt failure
  • Slit ventricle

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Slit Ventricle as a Neurosurgical Emergency : Case Report and Review of Literature. / Mencser, Zoltan; Kopniczky, Zsolt; Kis, David; Barzó, P.

In: World Neurosurgery, Vol. 130, 01.10.2019, p. 493-498.

Research output: Contribution to journalArticle

Mencser, Zoltan ; Kopniczky, Zsolt ; Kis, David ; Barzó, P. / Slit Ventricle as a Neurosurgical Emergency : Case Report and Review of Literature. In: World Neurosurgery. 2019 ; Vol. 130. pp. 493-498.
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