Subtemporal decompression: the treatment of noncompliant ventricle syndrome

To explore the effects of subtemporal decompression (STD) on the frequency of shunt revision and attendances with symptoms of raised intracranial pressure secondary to slit ventricle syndrome and slit ventricle-like syndrome. A renaming of these syndromes as noncompliant ventricle syndrome is suggested.

A retrospective review of the notes of all patients at our institution having STD from 1984 to 1997 was conducted.

Twenty-eight patients underwent STD (age range, 4-31 yr). Thirty-two STD procedures were performed. The mean follow-up duration after STD was 5.3 years (range, 0-12 yr). The number of shunt revisions before STD was 128 (mean, 4.6 revisions; range, 0-30 revisions) and after STD was 28 (mean, 1.0 revision; range, 0-7 revisions). The number of attendances before STD was 213 (mean, 6.7 attendances; range, 1-31 attendances) and after STD was 57 (mean, 1.8 attendances; range, 0-10 attendances). Among 15 patients for whom there was sufficient clinical data, 7 revisions were required during the 3 years before STD and 22 during the 3 years after STD. There were 53 admissions during the 3 years before STD and 11 during the 3 years after STD.

Although the overall incidence of shunt revision decreases, there is an early increase in the frequency of revision after STD. The number of admissions of patients with raised intracranial pressure symptoms reduces after STD, and we think that this is a more important factor in the consideration of this procedure than the number of recent revisions. We explore these arguments in this article.