Lumboperitoneal Shunting as a Treatment for Slit Ventricle Syndrome

Le, Hoang; Yamini, Bakhtiar; Frim, David M.

doi:10.1159/000056054

Cited by 62 publications

(38 citation statements)

References 15 publications

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“…More recently Le et al [30]have reported the use of lumboperitoneal shunting in addition to a functioning ventricular shunt. This provided good relief in all of their 7 patients with non-compliant ventricle syndrome.…”

Section: Introductionmentioning

confidence: 99%

The Problematic Slit Ventricle Syndrome

Olson¹

2004

Pediatr Neurosurg

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This review discusses the clinical difficulties with the so-called slit ventricle syndrome. It discusses why this terminology makes it difficult to formulate treatment algorithms. Slit ventricle syndrome should probably be known as the non-compliant ventricle syndrome to avoid confusion of radiological ‘slit ventricles’ with the syndrome. Therapeutic measures should ideally focus on the underlying pathology related to the syndrome. For those patients with iatrogenic small calvaria and synostosis, subtemporal decompression would appear a low-risk and quick procedure. Calvarial expansion would be a second-line treatment. For those patients with a normal-sized calvarium and non-compliant ventricle syndrome, valve upgrade, adding an antisiphon device or programmable valve would appear a good first step. For patients in whom the diagnosis is unclear, a potential management plan is discussed.

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Section: Introductionmentioning

confidence: 99%

The Problematic Slit Ventricle Syndrome

Olson¹

2004

Pediatr Neurosurg

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“…For most such cases, we advocate the use of LP shunts, which can drain both pathways. 15,34 In this case, however, the decision was complicated by the presence of the Chiari malformation Type II and NVH. We elected to explore the previous surgical site.…”

Section: Illustrative Cases 1 Andmentioning

confidence: 87%

“…Subsequently, the shunt failure resolved. Le and colleagues 15 reported that lumbar shunts selectively drained the CSAS after they observed that the lateral ventricles enlarged when an LP shunt was inserted for the treatment of SVS.…”

Section: Commentarymentioning

confidence: 99%

“…Strategies that are effective in the management of this difficult condition involve increasing the resistance of the valves in moderately affected patients while requiring shunt systems that access the CSAS through LP shunts or through shunts that access the cisterna magna. 15,16,20,28,32,34 Based on these experiences and observations of a referral practice for patients with severe problems related to shunt management, we have analyzed a group of enigmatic hydrocephalic conditions that may be explained with reference to changes in the volume of the CSAS.…”

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confidence: 99%

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The importance of the cortical subarachnoid space in understanding hydrocephalus

Rekate

Nadkarni

Wallace

2008

PED

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Object In this paper the authors define the role of the cortical subarachnoid space (CSAS) in poorly understood forms of hydrocephalus to cerebrospinal fluid (CSF) dynamics to improve understanding of the importance of the CSAS and its role in selecting patients for endoscopic third ventriculostomy (ETV). The secondary purpose of this work was to define testable hypotheses to explain enigmatic disorders of CSF dynamics and to suggest how these concepts could be tested. Methods The magnitude of the contribution of the CSAS is explored using the solid geometry of concentric spheres. With this starting point, clinical conditions in which CSF dynamics are not easily understood are explored regarding the potential role of the CSAS. Overall, problems of CSF dynamics are easily understood. Insights may be gained when the results of a pathological process or its treatment vary from what has been expected. Results Acute changes in ventricular volume at the time that hydrocephalus develops, the failure of shunts, and the changes in ventricular volume with shunt repair may occur very rapidly. Changes in the volume of water in the brain, especially in the brain substance itself, are unlikely to occur at this rapid rate and may be interpreted as a simple redistribution of the CSF between the ventricle and CSAS with no initial change in the actual volume of brain parenchyma. Problems such as pseudotumor cerebri, shunt failure with nonresponsive ventricles, and negative-pressure hydrocephalus can be explained by assessing the ability of ventricular CSF to flow to the CSAS and the ability of this fluid to exit this compartment. Ventricular enlargement at the time of shunt failure implies a failure of flow between the ventricles and CSAS, implying that all patients who show this phenomenon are potential candidates for ETV. Conclusions The important role of the CSAS in the pathophysiology of various forms of hydrocephalus has been largely ignored. Attention to the dynamics of the CSF in this compartment will improve understanding of enigmatic conditions of hydrocephalus and improve selection criteria for treatment paradigms such as ETV. These concepts lead to clearly defined problems that may be solved by the creation of a central database to address these issues.

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“…It is also performed for the treatment of CSF fistula, idiopathic intracranial hypertension (Burgett et al, 1997) and slit-ventricle syndrome (Le et al, 2002). Complications such as infection and malfunction were reportedly lower in LP shunt than VP shunt (Aoki, 1990).…”

Section: Lumboperitoneal Shunt (Lp Shunt)mentioning

confidence: 99%