Slit ventricle could be a neurosurgical emergency? Case Report

Symptomatic slit ventricle is one of complications of hydrocephalus shunting surgery in children. It is characterized by the clinical triad of headache, slow refilling of the valve and narrow ventricles on imaging. We report the case of a boy with a ventriculoperitoneal shunt due to preterm intraventricular hemorrhage, at 22 days of life. At age of 33 months, he started with symptoms of Slit Ventricles Syndrome. His parents did not consent to performing invasive diagnostic methods, so the boy only received symptomatic medication. At 40-month-old he had acute seizures without loss of consciousness and at that time computed tomography (CT) scan showed massive brain edema. At that time, an emergency frontal biparietal decompressive craniectomy was performed as an emergency procedure and an intracranial pressure catheter was placed, which demonstrated an intracranial pressure of 40 mmHg. The ICP continued to increase up to 100 mmHg without response to intensive medical treatment and after 24 hs, a boy developed brain death. Increased intracranial pressure (ICP) can lead to death in patients who previously undergone shunt treatment even in the absence of ventricular enlargement.