Panagopoulos Dimitrios, Gavra Maro, Boviatsis Efstathios, Korfias Stefanos, Themistocleous Marios
Neurosurgical Department, Pediatric Hospital of Athens, 45701 Athens, Greece.
Neuro-Radiology Department, Pediatric Hospital of Athens, 45701 Athens, Greece.
Children (Basel). 2024 May 15;11(5):596. doi: 10.3390/children11050596.
The main subject of the current review is a specific subtype of headache, which is related to shunt over-drainage and slit ventricle syndrome, in pediatric patients harboring an implanted shunt device for the management of hydrocephalus. This clinical entity, along with its impairment regarding the quality of life of the affected individuals, is generally underestimated. This is partly due to the absence of universally agreed-upon diagnostic criteria, as well as due to a misunderstanding of the interactions among the implicated pathophysiological mechanisms. A lot of attempts have been performed to propose an integrative model, aiming at the determination of all the offending mechanisms of the shunt over-drainage syndrome, as well as the determination of all the clinical characteristics and related symptomatology that accompany these secondary headaches. This subcategory of headache, named postural dependent headache, can be associated with nausea, vomiting, and/or radiological signs of slim ventricles and/or subdural collections. The ultimate goal of our review is to draw clinicians' attention, especially that of those that are managing pediatric patients with permanent, long-standing, ventriculoperitoneal, or, less commonly, ventriculoatrial shunts. We attempted to elucidate all clinical and neurological characteristics that are inherently related to this type of headache, as well as to highlight the current management options. This specific subgroup of patients may eventually suffer from severe, intractable headaches, which may negatively impair their quality of daily living. In the absence of any other clinical condition that could be incriminated as the cause of the headache, shunt over-drainage should not be overlooked. On the contrary, it should be seriously taken into consideration, and its management should be added to the therapeutic armamentarium of such cases, which are difficult to be handled.
本综述的主要主题是一种特定类型的头痛，它与植入分流装置以治疗脑积水的儿科患者的分流过度引流及裂隙脑室综合征有关。这种临床病症，连同其对受影响个体生活质量的损害，通常被低估。部分原因是缺乏普遍认可的诊断标准，以及对相关病理生理机制之间相互作用的误解。已经进行了许多尝试来提出一个综合模型，旨在确定分流过度引流综合征的所有致病机制，以及确定伴随这些继发性头痛的所有临床特征和相关症状。这种头痛的子类别，称为体位性头痛，可能与恶心、呕吐和/或脑室变窄和/或硬膜下积液的影像学征象有关。我们综述的最终目标是引起临床医生的注意，尤其是那些治疗患有永久性、长期存在的脑室腹腔分流术或较少见的脑室心房分流术的儿科患者的医生。我们试图阐明与这种类型头痛内在相关的所有临床和神经学特征，并强调当前的管理选择。这一特定亚组的患者最终可能会遭受严重的、难治性头痛，这可能会对他们的日常生活质量产生负面影响。在没有任何其他可被归咎为头痛原因的临床病症的情况下，不应忽视分流过度引流。相反，应认真考虑这一情况，并将其管理纳入此类难以处理病例的治疗手段之中。
