Incidental and Clinical Significance of Slit Ventricles in Fixed Pressure Valves.

Abstract

Slit ventricle syndrome (SVS) is arecognizeddelayed complication ofcerebrospinal fluid (CSF) shuntingin children. Ithad beenlinked to the use of low-pressureshuntsandconsidered anargument for the use of programmablevalves.In this study, weaim to assess the rate of SVSin childrenthat wereshuntedusingfixed-pressure valves. This study is a retrospective cohort study that occurred in King Abdulaziz Medical City, Jeddah, which reviews 100 patients with a median age of 15.5 months that were shunted by using fixed pressure valves during the period from 2010 to 2018. Fixed low-pressure valves were used in 69% of patients, while fixed medium-pressure valves were used in 31% of patients.SVS was defined by the presence ofslit-like ventricles (fronto-occipital [F-O] hornsratiowas ≤ 0.2 onanypost-shunt CT scan)andthe occurrence ofslit-like ventricle-related symptoms (chronic headache, nausea, vomiting,andaltered conscious level_ in theabsence ofother causes of shunt malfunction. The overall SVS ratein thecohortwas 6%. Nine childrenhadslit-like ventricles, butonly six of themwere symptomatic. Relatively higherSVSrateswereobservedinyoungermale children,obstructivehydrocephalus,andmedium-pressure valves.Slit-like ventricle-related symptoms in the absence of a slit-like ventriclewere reported in 24 out of 91 (26%)patients.A total of42 patients underwent shunt revisions for other complications.AllSVSpatients were treated conservatively.There was a temporal fluctuationin the F-O horns ratio andinsome patientswithSVStheirF-Ohornsratio returnedto normal atfurtherfollow-up without intervention. The overall SVS ratefollowing the use offixed-pressure CSFvalves in children is lowand managed conservatively. Not all patients withslit-like ventricles are symptomaticand the radiological appearance of SVS may improveon further follow-up without intervention.Fixed pressure valves remainan acceptabledevice inthetreatment of hydrocephalus in children.