Severe intracranial hypertension in slit ventricle syndrome managed using a cisterna magna–ventricle–peritoneum shunt

Rekate, Harold L.; Nadkarni, Trimurti; Wallace, Donna

doi:10.3171/ped.2006.104.4.240

Cited by 15 publications

(16 citation statements)

References 20 publications

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“…For patients with adult slit ventricle syndrome, the iatrogenic induction of ventriculomegaly typically requires complete cessation of CSF flow through the shunt (7,97). In our practice, the first stage is shunt externalization and placement of an ICP monitor.…”

Section: Inpatient Protocol For Shunt-dependence Assessmentmentioning

confidence: 99%

“…If ventricular enlargement cannot be attained, then a shunt revision is needed. We favor placement of a ventriculocisternoatrial shunt with an adjustable valve, typically in conjunction with limited suboccipital decompression (97). The rationale is to equalize the ventricular and subarachnoid/cisternal CSF pressure, thereby eliminating transmantle pressure gradients that promote collapse of the ventricular system.…”

Section: Inpatient Protocol For Shunt-dependence Assessmentmentioning

confidence: 99%

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Surgical Management of Adult Hydrocephalus

et al. 2008

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The management of adult hydrocephalus spans a broad range of disorders and ages. Modern management strategies include endoscopic and adjustable cerebrospinal fluid shunt diversionary techniques. The assessment and management of the following clinical conditions are discussed: 1) the adult patient with congenital or childhood-onset hydrocephalus, 2) adult slit ventricle syndrome, 3) multicompartmental hydrocephalus, 4) noncommunicating hydrocephalus, 5) communicating hydrocephalus, 6) normal pressure hydrocephalus, and 7) the shunted patient with headaches. The hydrodynamics of cerebrospinal fluid shunt diversion are discussed in relation to mechanisms of under- and overdrainage conditions. A rationale for the routine implementation of adjustable valves for adult patients with hydrocephalus is provided based on objective clinical and experimental data. For the condition of normal pressure hydrocephalus, recommendations are offered regarding the evaluation, surgical treatment, and postoperative management of this disorder.

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Section: Inpatient Protocol For Shunt-dependence Assessmentmentioning

confidence: 99%

Section: Inpatient Protocol For Shunt-dependence Assessmentmentioning

confidence: 99%

Surgical Management of Adult Hydrocephalus

et al. 2008

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“…Rekate et al 19 noted, "infants have open fontanelles and sutures that are capable of expanding. Decreased venous return in infants leads to hydrocephalus rather than pseudotumor.…”

Section: Venous Outflow Impairment: Hydrocephalus or Pseudotumor?mentioning

confidence: 99%

Hypertensive slit ventricle syndrome: pseudotumor cerebri with a malfunctioning shunt?

Bateman¹

2013

JNS

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Symptomatic shunt malfunction without ventricular enlargement is known as slit ventricle syndrome (SVS).Patients presenting with this syndrome are not a homogeneous group. Of the 5 different types classified by Rekate, Type 1 is caused by CSF overdrainage and is associated with low pressures; Types 2 and 3 are associated with shunt blockage and elevated CSF pressures; Type 4 is cephalocranial disproportion that increases brain parenchymal pressure but not CSF pressure; and Type 5 is headache unrelated to shunt function. The low and normal CSF pressure types are relatively well understood, but the high-pressure forms are more problematic. In the high-pressure forms of SVS it is said that the lack of ventricular dilation is related to a reduction in brain compliance analogous to idiopathic intracranial hypertension or pseudotumor cerebri. Despite this, there is little evidence in the literature to support this conjecture. With this in mind, 3 cases of SVS associated with elevated CSF pressure are presented. The MR venogram findings and hemodynamics of these 3 cases are shown to be identical to those of pseudotumor cerebri. A literature review indicates that an underlying venous impairment may be functioning in the patients who re-present with small ventricles following shunt malfunction.

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“…Doing so created a cisterna magna-ventricle-peritoneal shunt with a programmable valve with a device to retard siphoning. 20,32 To ensure that the pressure dynamics were ideal, we monitored the patient's ICP by using a parenchymal monitor for 48 hours. For the last 6 months she has not suffered headaches.…”

Section: Illustrative Cases 1 Andmentioning

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%

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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Severe intracranial hypertension in slit ventricle syndrome managed using a cisterna magna–ventricle–peritoneum shunt

Abstract: The CMVP shunts are an excellent option for patients who are not candidates for LP shunts but who have high ICP and ventricles that do not enlarge at shunt failure. The ability to access the spinal fluid in the cortical subarachnoid space presumably accounts for this success.

Cited by 15 publications

References 20 publications

Surgical Management of Adult Hydrocephalus

Surgical Management of Adult Hydrocephalus

Hypertensive slit ventricle syndrome: pseudotumor cerebri with a malfunctioning shunt?

The importance of the cortical subarachnoid space in understanding hydrocephalus

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