Infantile hydrocephalus and the slit ventricle syndrome in early infancy


Slit ventricle syndrome is well known as a complication in the treatment of hydrocephalus by shunting. It is generally considered to be a chronic (but not acute) complication, occurring years after the shunt procedure; there has been no report of this syndrome occurring before 1 year of age. The authors present infantile cases that developed a severe form of this syndrome shortly after shunt procedures and discuss the pathophysiology in comparison to experience with older cases. The causative factor was thought to be extremely low intracranial pressure with resultant microcephalus created by double or multiple shunt placement. The condition resulted in rapid onset of coma and respiratory arrest, which was successfully treated by subtemporal decompression or placement of an antisiphon device, with insertion of a higher pressure valve. The specific characteristics of infantile hydrocephalus are analyzed in the light of this complication from a series of 58 treated infants. In a follow-up of over 1 year in 42 cases, analysis revealed that slit ventricle occurs most frequently in immature young infants shunted before 1 month of age (85.7% or 18/21 cases). In contrast, subdural hematoma after shunting is an extremely rare phenomenon in premature or mature neonates. Slit ventricles were thought to result from high intracranial compliance due to the softer brain and more markedly widened cranial sutures of infantile hydrocephalus in the younger age group. The functioning period of the initial shunt was also much shorter in younger infants, and this may be because the ventricular shrinkage to a slit can cause shunt malfunction with or without developing the slit ventricle syndrome. The authors emphasize that development of slit ventricle after shunt placement should be prevented before it causes a damaging or, occasionally, a life-threatening condition.

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  1. 1.

    Becker DP, Nulsen FE (1968) Control of hydrocephalus by valve-regulated venous shunt: avoidance of complications in prolonged shunt maintenance. J Neurosurg 28:215–226

    Google Scholar 

  2. 2.

    Bering EA Jr (1962) Circulation of the cerebrospinal fluid. Demonstration of the choroid plexuses as the generator of the force for flow of fluid and ventricular enlargement. J Neurosurg 19:405–412

    Google Scholar 

  3. 3.

    Epstein FJ, Fleischer AS, Hochwald GM, Ransohoff J (1974) Subtemporal craniectomy for recurrent shunt obstruction secondary to small ventricles. J Neurosurg 41:29–31

    Google Scholar 

  4. 4.

    Epstein FJ, Hochwald GM, Wald A, Ransohoff J (1975) Avoidance of shunt dependency in hydrocephalus. Dev Med Child Neurol [Suppl 35] 17:71–77

    Google Scholar 

  5. 5.

    Epstein F, Marin AE, Wald A (1978) Chronic headaches in the shunt-dependent adolescent with nearly normal ventricular volume: diagnosis and treatment. Neurosurgery 3:351–355

    Google Scholar 

  6. 6.

    Faulhauer K, Schmitz P (1978) Overdrainage phenomena in shunt treated hydrocephalus. Acta Neurochir (Wien) 45:89–101

    Google Scholar 

  7. 7.

    Gruber R (1981) The relationship of ventricular shunt complications to the chronic overdrainage syndrome: follow-up study. Z Kinderchir 34:346–352

    Google Scholar 

  8. 8.

    Holness RO, Hoffman HJ, Hendrick EB (1979) Subtemporal decompression for the slit-ventricle syndrome after shunting in hydrocephalic children. Child's Brain 5:137–144

    Google Scholar 

  9. 9.

    Hyde-Rowan MD, Rekate HL, Nulsen FE (1982) Reexpansion of previously collapsed ventricles: the slit ventricle syndrome. J Neurosurg 56:536–539

    Google Scholar 

  10. 10.

    Kaufman B, Weiss MH, Young HF, Nulsen FE (1973) Effects of prolonged cerebrospinal fluid shunting on the skull and brain. J Neurosurg 38:288–297

    Google Scholar 

  11. 11.

    Kiekens R, Mortier W, Pothman R, Bock WJ, Seibert H (1982) The slit-ventricle syndrome after shunting in hydrocephalic children. Neuropediatrics 13:190–194

    Google Scholar 

  12. 12.

    Linder-Diehl J, Sklar FH (1983) Subtemporal decompressions for shunt-dependent ventricles: mechanism of action. Surg Neurol 19:520–523

    Google Scholar 

  13. 13.

    Oi S (1983) Slit like ventricle and isolation of CSF pathway as complications of shunt procedure in child hydrocephalus. I. The pathophysiology and clinical problems (in Japanese). Shoni No Noshinkei 8:107–117

    Google Scholar 

  14. 14.

    Oi S (1983) Slit like ventricle and isolation of CSF pathway as complications of shunt procedure in child hydrocephalus. II. Development of antislit ventricular catheter and the experimental study (in Japanese). Shoni No Noshinkei 8:119–127

    Google Scholar 

  15. 15.

    Oi S, Matsumoto S (1985) Infantile hydrocephalus — characteristics and clinical problems. I. Post-operative complications of shunt procedure (in Japanese). Shoni No Noshinkei 10:353–360

    Google Scholar 

  16. 16.

    Oi S, Matsumoto S (1985) Slit ventricles as a cause of isolated ventricles after shunting. Child's Nerv Syst 1:189–193

    Google Scholar 

  17. 17.

    Oi S, Matsumoto S (1985) Pathophysiology in non-neoplastic obstruction of the foramen of Monro and progressive unilateral hydrocephalus. Neurosurgery 17:891–896

    Google Scholar 

  18. 18.

    Oi S, Matsumoto S (1986) Morphological findings of post-shunt slit-ventricle in experimental canine hydrocephalus: aspects of causative factor for isolated ventricles and slit-ventricle syndrome. Child's Nerv Syst 2:179–184

    Google Scholar 

  19. 19.

    Oi S, Matsumoto S (1986) Dynamic change in intracranial pressure in slit-like ventricle and isolated ventricles in post-shunted child hydrocephalus. In: Ishii S (ed) Proceedings of the International Symposium on Hydrocephalus. Excerpta Medica, Amsterdam, pp 135–147

    Google Scholar 

  20. 20.

    Oi S, Matsumoto S (1986) Slit like ventricle and isolation of CSF pathway as complications of shunt procedure in child hydrocephalus. VI. Pathophysiology and treatment of isolated unilateral hydrocephalus (in Japanese). Shoni No Noshinkei 11:249–256

    Google Scholar 

  21. 21.

    Oi S, Yamada H, Ijichi A, Sasaki K, Matsumoto S (1984) Slit like ventricle and isolation of CSF pathway as complications of shunt procedure in child hydrocephalus. IV. Slit ventricle syndrome (in Japanese). Shoni No Noshinkei 9:317–324

    Google Scholar 

  22. 22.

    Oi S, Shose Y, Yamada H, Ijichi A, Matsumoto S (1986) CSF dynamics in children: a quantitative analysis of relativity of major and minor pathways of cerebrospinal fluid dynamics (in Japanese). CT Kenkyu 8:153–162

    Google Scholar 

  23. 23.

    Salmon JH (1978) The collapsed ventricle: management and prevention. Surg Neurol 9:349–352

    Google Scholar 

  24. 24.

    Sutton LN, Bruce DA, Schut L (1980) Hydranencephaly versus maximal hydrocephalus: an important clinical distinction. Neurosurgery 6:35–38

    Google Scholar 

  25. 25.

    Walsh JW, James HE (1982) Subtemporal craniectomy and elevation of shunt valve opening pressure in the management of small ventricle-induced cerebrospinal fluid shunt dysfunction. Neurosurgery 10:698–703

    Google Scholar 

  26. 26.

    Yelin EF, Ehni G (1969) Percallosal sump ventriculostomy for shunt-dependent hydrocehalic patient with small ventricles. J Neurosurg 31:570–573

    Google Scholar 

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Correspondence to Shizuo Oi.

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Oi, S., Matsumoto, S. Infantile hydrocephalus and the slit ventricle syndrome in early infancy. Child's Nerv Syst 3, 145–150 (1987).

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Key words

  • Infantile hydrocephalus
  • Shunt complication
  • Slit ventricle syndrome
  • Overdrainage
  • Microcephalus