Alghamdi Khalid T, Alghamdi Mohammed D, Neazy Sultan, Algamdi Mohannd M, Alzahrani Abdullah, Khan Muhammad A, Algahtani Abdulhadi
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, Jeddah, SAU.
Internal Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, Jeddah, SAU.
Cureus. 2022 Oct 31;14(10):e30902. doi: 10.7759/cureus.30902. eCollection 2022 Oct.
Slit ventricle syndrome (SVS) is a recognized delayed complication of cerebrospinal fluid (CSF) shunting in children. It had been linked to the use of low-pressure shunts and considered an argument for the use of programmable valves. In this study, we aim to assess the rate of SVS in children that were shunted using fixed-pressure valves.
This study is a retrospective cohort study that occurred in King Abdulaziz Medical City, Jeddah, which reviews 100 patients with a median age of 15.5 months that were shunted by using fixed pressure valves during the period from 2010 to 2018. Fixed low-pressure valves were used in 69% of patients, while fixed medium-pressure valves were used in 31% of patients. SVS was defined by the presence of slit-like ventricles (fronto-occipital [F-O] horns ratio was ≤ 0.2 on any post-shunt CT scan) and the occurrence of slit-like ventricle-related symptoms (chronic headache, nausea, vomiting, and altered conscious level_ in the absence of other causes of shunt malfunction.
The overall SVS rate in the cohort was 6%. Nine children had slit-like ventricles, but only six of them were symptomatic. Relatively higher SVS rates were observed in younger male children, obstructive hydrocephalus, and medium-pressure valves. Slit-like ventricle-related symptoms in the absence of a slit-like ventricle were reported in 24 out of 91 (26%) patients. A total of 42 patients underwent shunt revisions for other complications. All SVS patients were treated conservatively. There was a temporal fluctuation in the F-O horns ratio and in some patients with SVS their F-O horns ratio returned to normal at further follow-up without intervention.
The overall SVS rate following the use of fixed-pressure CSF valves in children is low and managed conservatively. Not all patients with slit-like ventricles are symptomatic and the radiological appearance of SVS may improve on further follow-up without intervention. Fixed pressure valves remain an acceptable device in the treatment of hydrocephalus in children.
裂隙脑室综合征（SVS）是儿童脑脊液（CSF）分流术后一种公认的迟发性并发症。它与低压分流管的使用有关，并被视为使用可编程阀门的一个理由。在本研究中，我们旨在评估使用固定压力阀门进行分流的儿童中SVS的发生率。
本研究是一项回顾性队列研究，在吉达的阿卜杜勒阿齐兹国王医疗城进行，回顾了2010年至2018年期间100例使用固定压力阀门进行分流的患者，中位年龄为15.5个月。69%的患者使用了固定低压阀门，31%的患者使用了固定中压阀门。SVS的定义为出现裂隙样脑室（任何分流后CT扫描的额枕[F - O]角比率≤0.2）以及在没有其他分流故障原因的情况下出现与裂隙样脑室相关的症状（慢性头痛、恶心、呕吐和意识水平改变）。
该队列中SVS的总体发生率为6%。9名儿童有裂隙样脑室，但其中只有6名有症状。在年龄较小的男性儿童、梗阻性脑积水和使用中压阀门的患者中观察到相对较高的SVS发生率。91名患者中有24名（26%）报告了在没有裂隙样脑室情况下出现的与裂隙样脑室相关的症状。共有42名患者因其他并发症接受了分流管修复。所有SVS患者均接受保守治疗。F - O角比率存在时间波动，一些SVS患者在进一步随访时未经干预其F - O角比率恢复正常。
儿童使用固定压力CSF阀门后的总体SVS发生率较低，且采用保守治疗。并非所有有裂隙样脑室的患者都有症状，SVS的放射学表现可能在进一步随访时未经干预而改善。固定压力阀门仍然是治疗儿童脑积水的一种可接受的装置。
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