Short-term dexamethasone treatment for symptomatic slit ventricle syndrome

Abstract

Fattal-Valevski et al. have reported on the use of dexamethasone as part of the treatment for symptomatic slit ventricle syndrome in 13 patients. This appears to be the first report in the literature specifically describing the use of dexamethasone or any other corticosteroid as part of the treatment of this difficult condition. In our institution, dexamethasone has also been used occasionally for the treatment of patients with slit ventricle syndrome and I expect that there are many neurosurgeons who have done the same. However, this treatment modality has not been reported in the literature and I compliment the authors for having reviewed their experience and reported on it. I am sure that with this report the use of dexamethasone as part of the management protocol for slit ventricle syndrome will increase. The concept of using steroids for the treatment of presumed intracranial hypertension in the presence of small ventricles is not new. It certainly is one of the therapeutic modalities that have been used in the management of pseudotumor cerebri [1], and in some respects slit ventricle syndrome resembles this condition. The authors have provided details about the dose of dexamethasone that was used (0.5 mg/kg per day) and duration of treatment (3–10 days). They have not indicated, however, how they decide on the duration of the medication and that would be helpful. Furthermore, there are patients with slit ventricle syndrome in whom headaches occur intermittently and last for only hours. I would presume that these children are not candidates for the use of dexamethasone and that the dexamethasone is restricted to those patients who have more continuous headaches, lasting more than 24 or 48 h. Again, the authors could provide more guidance for readers by being more specific about the nature of the patients in whom they would initiate dexamethasone treatment.