History of Management of Slit Ventricle Syndrome in Children

Understanding of Disease

• 1982 – slit ventricle syndrome defined: Headaches are very common in children with shunts.  The classic definition of small ventricles, a slowly filling shunt reservoir, and chronic intermittent headaches form the basis of the clinical diagnosis (2).
• Ongoing refinement of definition: Understanding of the slit ventricle syndrome has evolved beyond this simplistic definition as a more detailed understanding of cerebral physiology has emerged.  Original descriptions of slit ventricle syndrome management predicted a more complex interplay of ventricular volume and pressure and included descriptions of small ventricles (normal volume ventricles) and shunt revision for occluded catheters (1).

Technological Development

• Monitoring ICP: ICP monitoring can be done safely and for prolonged periods of time with portable monitors, obviating the need for lumbar puncture or accessing the shunt hardware. Monitoring the patient supine, sitting, standing, and ambulating can be useful.

Surgical Technique

• ETV: As surgeons gained comfort with ETV, they began to report on managing slit ventricle syndrome with an ETV after externalization of the shunt and controlled enlargement of the ventricles (12).