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Positional shunt assist for slit ventricle syndrome

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Abstract

Purpose

Hydrocephalus is one of the most common pathologies in pediatric neurosurgery. One of the causes of recurring events of headaches among shunted children is “slit ventricle syndrome” (SVS). Several potential treatments have been proposed, yet SVS often represents a treatment challenge. The goal of the current series is to present our experience with adding a positional shunt-assist (SA) (Miethke, Aesculap) for the treatment of SVS.

Methods

Clinical data was retrospectively collected from all consecutive children with SVS that were treated with SA (Miethke, Aesculap) at our center. Surgical and clinical outcomes as expressed by hospital visits, or need for additional surgery, were evaluated.

Results

Nine cases were included. Hydrocephalus etiology included IVH (6), postinfectious (1), and congenital syndromes (2). Average age at first shunt was 4 months. Primary shunt type was differential-pressure-valve in all. Average age at SVS onset was 4 years. Average age at SA placement was 5.5 years. There were no perioperative complications besides a single stich abscess. A 6-month follow-up period after SA was compared to a 6-month period prior to the SA: average hospital visits decreased from 2.4 to 0.6 per patient (p < 0.0002). 4/9 patients needed an LP or shunt revision before the SA surgery, while no procedure was indicated during the immediate 6-month follow-up. At the last follow-up, there was a significant reduction in the rate of ER visits compared to prior to surgery; however, the number of neurosurgical procedures did not significantly differ.

Conclusion

Using a SA for SVS was associated with a short-term improvement of symptoms in the majority of cases, reduction in hospital visits, and reduced need for SVS-related procedures.

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Availability of data and materials

The data that support the findings of this study are available on request from the corresponding author.

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Acknowledgements

We thank Mrs. Adina Sherer for editorial assistance and Moran Artzi and Tomer Ziv-Baran for their contribution to the statistical analysis.

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Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Dana Children’s Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel

    Lee Azolai, Shlomi Constantini, Lahav Constantini & Jonathan Roth

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  1. Lee Azolai
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  2. Shlomi Constantini
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  3. Lahav Constantini
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  4. Jonathan Roth
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Contributions

Conception and design: Roth and Constantini S. Acquisition of data: Azolai and Constantini L. Analysis and interpretation of data: Azolai and Roth. Drafting the article: Azolai and Roth. Critically revising the article: all authors. Review of the submitted version of the manuscript: all authors. Approval of the final version of the manuscript on behalf of all authors: Roth. Study supervision: Roth.

Corresponding author

Correspondence to Jonathan Roth.

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Ethics approval

This study was approved by Helsinki Committee (0198–22-TLV).

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The authors report no competing of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Azolai, L., Constantini, S., Constantini, L. et al. Positional shunt assist for slit ventricle syndrome. Childs Nerv Syst 40, 109–114 (2024). https://doi.org/10.1007/s00381-023-06145-2

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