Effectiveness of subtemporal decompression for the management of slit ventricle syndrome

Abstract

Objectives

To assess the effectiveness of subtemporal decompression in the management of slit ventricle syndrome.

Methods

We conducted a retrospective review of all patients with slit ventricle syndrome (SVS) who underwent subtemporal decompression (STD) at our centre between 2010 and 2021. Cases were identified using the hospital database. Medical records for each patient were reviewed, including operative and radiological reports.

Results

Fifteen patients underwent STD for the management of SVS. Median age at time of STD was 9.18 years. Aetiology of hydrocephalus consisted of spinal dysraphism (5), idiopathic (4), post-infectious (1), post-haemorrhagic (3), secondary to tumour (1), and craniofacial anomalies (1). Median age at first shunt insertion was 3.4 months. Median pre-operative period assessed, from initial shunt insertion to STD, was 4.54 (interquartile range [IQR] 3.12–10.47) years. Twelve patients underwent ≥1 shunt revision prior to STD. All patients had a diagnosis of SVS at time of STD. Presenting symptoms, for the admission in which STD was performed, included nausea (9), vomiting (8), lethargy (8), headache (12), irritability (5), and visual disturbances (6). One third underwent shunt revision at the time of STD. Two patients developed post-operative complications requiring further surgery (meningitis requiring shunt revision: 1; wound debridement: 1). Three patients developed uncomplicated post-operative pyrexia, which was managed with antibiotics. Median duration of post-operative follow-up was 5.4 (IQR 1.73–8.54) years. Eleven patients underwent ≥1 shunt related procedure following STD. Wilcoxon signed-rank test demonstrated a significant difference in number of shunt related procedures before (median = 5, IQR 1–8) and after (median = 3, IQR 0–5) STD (Z = −2.083, p = .037). All patients reported subjective symptom improvement post-operatively. Thirteen patients experienced symptom recurrence at a median duration of 10 months post-operatively.

Conclusions

STD was associated with a reduction in the amount of shunt related procedures required in this group of patients with SVS. Further study is required to confirm this association.

Keywords:

• Hydrocephalus
• slit ventricle syndrome
• neurosurgical procedures
• craniotomy
• cerebrospinal fluid shunts

Acknowledgements

We thank Mr Aidan Beegan, Biostatistician at Children’s Health Ireland (CHI) Clinical Research Centre, for his guidance on statistical methods and data analysis. We thank Mr Kenny Lynch, Project Data Manager at CHI Clinical Research Centre, for his assistance with data management. We thank Mr Ciaran Greaney for his work in managing the Data Protection Impact Assessment. We thank the CHI Clinical Research and Innovation Centre for their support throughout the project.

Disclosure statement

The authors report there are no competing interests to declare.

Additional information

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.