Chronic headache associated with a functioning shunt

Abstract

Chronic headaches in a shunt-dependent patient with small ventricles has long been treated with little or no regard to intracranial pressure. In this study, pressure monitoring on 12 such patients demonstrated that they fell into three distinct categories: 3 had headaches caused by intracranial hypertension, 2 had headaches from hypotension, and 7 showed no relation of symptoms to pressure. As therapeutic procedures for treating these three categories are entirely different and sometimes opposing, it is clear that intracranial pressure monitoring is essential to successful management of this complaint.

Changes in Intracranial Pressure after Calvarial Expansion Surgery in Children with Slit Ventricle Syndrome

“…The condition appears to result from excessive drainage of CSF from the ventricular cavities, with a peak incidence in the first decade of life [1, 7]. Though the symptom complex may be quite characteristic (headache, irritability, nausea, vomiting and lethargy), different underlying causes and ICP abnormalities may be identified [1, 3, 4, 5, 6, 15, 18]. …”

“…Several authors have previously demonstrated the value of continuous ICP monitoring in patients with SVS [5, 15, 18]. It has been shown that patients with low and high ICP may present with similar symptoms and radiological findings.…”

“…According to this classification, the patients presented here belong to the group designated ‘intracranial hypertension with working shunts’. It should be noted that several authors have assessed ICP by placing a sensor in the shunt chamber [5, 15, 18]. Since this approach only provides recordings of pressure in the shunt reservoir, partial or total occlusion of the ventricular catheter may give misleading pressure recordings.…”

“…The condition may involve different underlying causes and various intracranial pressure (ICP) abnormalities [3, 4]. Depending on the underlying cause, numerous treatment strategies have been advocated, including conservative treatment, shunt revision, shunt removal, third ventriculostomy, antimigrainous therapy, high resistant or antisiphon valves and subtemporal craniectomy (STC) [1, 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13]. …”

The Problematic Slit Ventricle Syndrome

“…The presentation is a triad of intermittent clinical features of shunt obstruction, slit-like appearance of ventricles on CT scanning and slow refill of shunt pumping devices [3, 4, 5]. The proposed pathophysiology behind the symptomatology is that small ventricles predispose to catheter obstruction, the pressure then rises and only when the ventricles marginally dilate does the catheter begin to function again [3, 6, 7, 8, 9]. …”