LAUSR

OBJECTIVE Slit ventricle syndrome (SVS) is an iatrogenic disease occurring in patients with ventriculoperitoneal shunt. This paper reports the management modalities and results in a case-series from a single center. METHODS We reviewed a series 48 hospitalized patients with severe SVS that we managed in a ten-year period. Thirty-seven patients harboring programmable valves (P-valve) first underwent attempts at valve reprogramming This produced no effect in 21 subjects who therefore required surgical treatment. Surgery was also required by 11 patients without P-valve. Accordingly, a total of 32 patients had to be operatively treated by shunt externalization followed by valve replacement or ETV basing on intracranial pressure and ventricular size. The new valve was either ProGav® Mietke (Aesculap) or Medos® Codman (Integra) both equipped with their own antisiphon system. In selected cases a programmable antisiphon system (ProSa® - Mietke) was used. RESULTS Surgical mortality was 3% and major morbidity accounted for 6%. Complete resolution was obtained in 55% of cases, improvement in 32% and no effect or worsening in 13%. One only patient became shunt-free following ETV. Medos and ProGrav provided comparable outcomes while ProSa was determinant in selected cases. Pediatric age, uncomplicated shunt courses, and short SVS histories were significantly favorable indicators. CONCLUSIONS SVS management remains problematic. However, this study individuated factors that may improve the outcome, such as wider use of P-valves to treat hydrocephalus, timely diagnosis of overdrainage and earlier and more aggressive indications to manage the SVS.