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.3171/jns.1982.56.4.0524 Skull growth after coronal suturectomy, periostectomy, and dural transection William J. Babler John A. Persing K. Maurits Persson H. Richard Winn John A. Jane George T. Rodeheaver April 1982 56 4 529 535 10.3171/jns.1982.56.4.0529 Reexpansion of previously collapsed ventricles: the slit ventricle syndrome M. Deborah Hyde-Rowan Harold L. Rekate Frank E. Nulsen April 1982 56 4 536 539 10.3171/jns.1982.56.4.0536 Congenital inclusion cyst of the subgaleal space A. Basit Chaudhari Foluso Ladapo Victor P. N. Mordi Kalyanpury J. Choudhury

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M. Deborah Hyde-Rowan, Harold L. Rekate and Frank E. Nulsen

S ince the development in 1952 of the valve-regulated shunt by Nulsen and Spitz, 6 hydrocephalus has been successfully treated by various procedures. 9 One of the well recognized complications of shunting has been that of overdrainage, resulting in slit or subnormal-sized ventricles. These events have created a relatively new phenomenon, the “slit ventricle syndrome.” This syndrome occurs in shunt-dependent patients and is characterized by the following triad of events: 1) intermittent or chronic headaches secondary to episodic ventricular catheter

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Slit Ventricle Syndrome March 1983 58 3 10.3171/jns.1983.58.3.0456 Brain-Stem Hematomas March 1983 58 3 10.3171/jns.1983.58.3.0456a Thrombosed Arteriovenous Malformations March 1983 58 3 10.3171/jns.1983.58.3.0457 Intermittent Exophthalmos March 1983 58 3 10.3171/jns.1983.58.3.0458 Femoral Nerve Injury March 1983 58 3 10.3171/jns.1983.58.3.0459 Long-Term Indwelling Brain Cannula March 1983 58 3 10.3171/jns.1983.58.3.0459a Monitoring of Auditory Evoked Potentials March 1983 58 3 10.3171/jns.1983.58.3.0460 Multiple Giant

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Neurosurgical Forum: Letters to the editor To The Editor Valter da Costa , M.D. Goiânia, Goiás, Brazil 456 456 I would like to congratulate Dr. Hyde-Rowan, et al. , for the excellent article about the slit ventricle syndrome (Hyde-Rowan MD, Rekate HL, Nulsen FE: Reexpansion of previously collapsed ventricles: the slit ventricle syndrome. J Neurosurg 56: 536–539, April, 1982). I wish to add two more references to their bibliography of this very interesting shunt complication. Salmon 2 achieved good results in

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Rolf Gruber, Peter Jenny and Bruno Herzog

identifying and recognizing the problem is reduced. The pathogenic origin of a chronic overdrainage (or slit-ventricle) syndrome is the suction-induced collapse of the ventricular wall around the draining catheter causing an intermittent and ultimately irreversible obstruction of the shunt system. This results in recurrent and finally acute progressive elevated intracranial pressure (ICP). 7 During the emergency revision of the obstructed ventricular catheter, the insertion of a new catheter into the slit-like collapsed ventricle is difficult and a bilateral subtemporal

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Michael J. Noetzel and Roy P. Baker

within the peritoneum in two. Since the interval between the taps and subsequent malfunction was long (mean 17 months), it is unlikely that the taps played any role in the development of the obstruction. The remaining case of post-tap revision was a consequence of the slit ventricle syndrome which evolved 5 years after the shunt fluid examination. Two shunt-related infections occurred subsequent to taps. In both instances the responsible bacterial pathogen was Haemophilus influenzae ; one case presented as meningitis following pneumonia and the other as an infected

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Pressure-volume relationships in shunt-dependent childhood hydrocephalus

The zone of pressure instability in children with acute deterioration

Kenneth Shapiro and Arno Fried

little enlargement of the ventricles. In some of these children the ventricles do not enlarge at all, leading some authors to coin the term “slit ventricle syndrome.” 5, 12, 31 In the other group, more subtle deterioration occurs, manifested by loss of developmental milestones or deterioration in schoolwork. 9 Most children in this latter group have long-standing but less overt symptoms of raised intracranial pressure (ICP). In our experience, ventricular size tends to be larger in these children than in those with more precipitous deterioration. Previous work from

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Subtle deterioration in shunted childhood hydrocephalus

A biomechanical and clinical profile

Arno Fried and Kenneth Shapiro

Sci 8: 227–228, 1982 10. Hemmer R , Böhm B : Once a shunt, always a shunt? Dev Med Child Neurol 18 (Suppl 37) : 69 – 73 , 1976 Hemmer R, Böhm B: Once a shunt, always a shunt? Dev Med Child Neurol 18 (Suppl 37): 69–73, 1976 11. Holness RO , Hoffman HJ , Hendrick EB : Subtemporal decompression for the slit-ventricle syndrome after shunting in hydrocephalic children. Childs Brain 5 : 137 – 144 , 1979 Holness RO, Hoffman HJ, Hendrick EB: Subtemporal decompression for the slit-ventricle

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R. Michael Scott, Samuel M. Wolpert, Louis E. Bartoshesky, Seymour Zimbler and George T. Klauber

-extremity function was recovered. At 3 years of age, she experienced progressive arm weakness and underwent a repeat cervicomedullary exploration with drainage of a small hydromyelia. She has also had several subsequent operations for slit-ventricle syndrome. In addition to progressive scoliosis and spasticity, bladder function had also deteriorated, with diminished bladder capacity and worsening of continence between catheterizations. Myelography performed several years previously had demonstrated a “tethered cord,” although the exact configuration of the caudal spinal cord was

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Christian Sainte-Rose, Michael D. Hooven and Jean-François Hirsch

obtained 7 days after shunt placement in the same three patients. Lower: Scans obtained 3 months postoperatively in two patients. In one child with a post-shunt slit-ventricle syndrome, the low-resistance DP valve, which was not obstructed, was replaced by an OSV but the catheters were not changed. Normalization of ICP occurred progressively within 2 weeks while the ventricles recovered to a normal size within 10 days 44 ( Fig. 18 ). Fig. 18. Left: Intracranial pressure recordings in a patient with a slit-ventricle syndrome in whom a low