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Published on: February 9, 2024
Modified bilateral subtemporal decompression for resistant slit ventricle syndrome
Jonathan Roth1, Naresh Biyani, Suhas Udayakumaran
1Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel.
Insights
Bilateral subtemporal decompression effectively treats severe slit ventricle syndrome (SVS) in children. This surgical approach offers a high success rate, improving outcomes for patients with resistant SVS.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Hydrocephalus Management
Background:
- Slit ventricle syndrome (SVS) poses significant challenges in pediatric hydrocephalus management.
- Optimal surgical interventions for severe and resistant SVS remain debated, lacking a definitive consensus.
Observation:
- A modified bilateral subtemporal decompression with dura and arachnoid opening was performed on 15 children with severe, resistant SVS.
- Clinical and radiological data were retrospectively analyzed to evaluate the treatment's efficacy.
Findings:
- Complete recovery was observed in 46.6% of patients.
- An additional 26.6% required proximal shunt revision after ventricular dilation, with positive outcomes.
- Overall, 73.4% of patients experienced very good outcomes following the decompression procedure and subsequent interventions.
Implications:
- Modified bilateral subtemporal decompression is a highly effective treatment for severe and resistant SVS in pediatric patients.
- Proximal shunt revision is a viable option for select patients experiencing ventricular dilation post-decompression.
- Further cranial vault expansion should be considered for refractory cases with persistent small ventricles.
Purpose:
Slit ventricle syndrome (SVS) remains a major problem for early shunted children. Several conservative and surgical treatment paradigms have been suggested; however, there is no consensus on the optimal surgical treatment. We present our experience using bilateral subtemporal decompressions with dura and arachnoid opening for the treatment of a subgroup of children with severe and resistant SVS.
Methods:
Fifteen children with severe and resistant SVS underwent a modified bilateral subtemporal craniectomy, with dura and arachnoid opening. Their clinical and radiological data were retrospectively reviewed.
Results:
Seven (46.6%) patients had a complete recovery from their symptoms with a follow-up of 5.9 ± 2.6 years.The remaining eight (53.3%), underwent additional surgeries. Four (26.6%), had a single proximal shunt revision after dilatation of their ventricles. Following these procedures these four children are well and stable with a follow-up of 1.8 ± 2 years. The other four had further cranial vault expansion, one of which was followed by a proximal shunt revision. Thus, 11 of these 15 patients (73.4%) had a very good outcome, attributable to this technique, with a mean follow-up of 4.5 ± 3 years.
Conclusions:
Modified bilateral subtemporal decompression with dura and arachnoid opening yields a high cure rate for severe and resistant slit ventricle syndrome. Proximal shunt revision may be safely performed in a subset of patients that dilate their ventricles following the procedure. Further cranial expansion may be reserved for children with recurrent SVS symptoms who do not respond to STD and remain with very small ventricles.
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