Non-invasive intracranial pressure monitoring in management of slit ventricle syndrome - Case report

Slit ventricle syndrome (SVS) is condition of severe headaches, usually intermittent, suffered by patients after ventricular shunting for hydrocephalus with normal or smaller ventricle size, although in some cases the correct diagnosis and management can be a significant challenge. This case report aims to highlight the application of non-invasive ICP monitoring (nICP) technology in the diagnose and management of SVS providing insights into its benefits and limitations. A 6-year-old boy with a known history of autism spectrum disorder had undergone a VPS for a communicating hydrocephalus. Post operative, patient was asymptomatic with magnetic resonance images (MRI) showing small ventricle size. However, the patient started to develop recurrent symptoms of headache, nausea, and vomiting, a fresh MRI was ordered which demonstrated findings consistent with the previous MRI. We therefore decided to evaluate ICP and compliance by non-invasive monitoring using brain4care technology. Noninvasive monitoring was suggestive of low ICP and hyperdrainage, leading to the adjustment of the shunt valve from a medium to high pressure device, which normalized ICP waves and ICP as well ventricles size and the patient became asymptomatic. Therefore, we propose that noninvasive ICP monitoring may be a helpful tool to better classify the SVS type and guide the appropriated management.