Slit-ventricle syndrome: review of 15 cases

The slit-ventricle syndrome (SVS) has been the subject of diverse opinions and recommendations during the past 2 decades. In an effort to define the clinical features of SVS and to make recommendations concerning management we have reviewed 15 cases treated by a fairly uniform technique during the past 5 years. The syndrome consists of: (1) intermittent, but self-limiting episodes resembling shunt malfunction, usually lasting a few days, (2) nonfilling of the pumping device after compression, and (3) a slit-like ventricular system on CT scan. In all but 2 patients the initial shunt was performed in infancy. The mean interval from the initial shunt to treatment of SVS was 6 years. The age range at onset of SVS varied from 2 to 17 years with a mean of 7 years. All patients in this series were relieved of symptoms by placement of an antisiphon device and, in most patients, upgrading the valve resistance. Analysis of this series has led to the following conclusions: (1) SVS is a characteristic clinical entity, usually distinguishable from persistent shunt malfunction and from low-pressure headache, (2) the pathogenesis is intermittent obstruction of the ventricular catheter, (3) there is no good evidence that changes of brain compliance or La Place principles apply, and (4) placement of antisiphon device and upgrading valve resistance are effective treatments.