doi: 10.25005/2074-0581-2020-22-1-45-55

A.A Sufianov1,2, R.R. Rustamov1,2, Yu.A. Yakimov1,2, R.A. Sufianov1,2, A.A. Alzehrani1, L.A. Borba3, L. Mastronardi1,4, I.A. Balel1

1Department of Neurosurgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
2Federal Center for Neurosurgery, Tyumen, Russian Federation
3Clinic of Neurosurgery, Evangelical Medical School, Federal University of Parana City, Parana, Brazil
4Department of Neurosurgery, San Filippo Neri Hospital, Rome, Italy

Objective: Objective: To demonstrate the results of neuroendoscopic operations for achievement of shunt-independent condition in treatment of slit ventricle syndrome.

Methods: Forty-three cases were considered: adult patients aged 18 years and over – 5 (11.63%), and children aged 0-17 years – 38 (88.37%). Pediatric patients were divided into the following age groups: under 1 year – 6 (13.95%); 1-2 years – 7 (16.28%); 2-17 years – 25 (58.14%). The interval between operations was an average of 2 years 6 months (from 1 week to 16 years), and the period of observation after surgery – an average of 41.8 months (from 1 week to 100 months).

Results: In children under 1 year, the efficiency was 83.3%; 1-2 years old – 71.4%; 2-17-years old – 92%; 60% of adult patients aged 18 and over. The effectiveness of operations performed using standard rigid endoscopes was 72.1%, and using a semi-rigid needle-shaped endoscope – 95.2%. In total, the overall efficiency of the ETV, aqueductoplasty, choroid plexus coagulation, cystocysternostomy, septostomy, ventricular stenting, revision and reconstruction of VPS, plasty and stenting of Foramen of Magendie and Lyushka, independently from the age of the patients, type of endoscopes was 83%. In 68.3% of cases shunt-independent state was achieved.

Conclusion: Endoscopic methods have shown their high effectiveness in the treatment of patients with slit ventricle syndrome and other complications of hydrocephalus. Using a more advanced modern endoscopic technique, such as a semi-rigid needle endoscope in our case, allows to restore CSF circulation even in the most distal sections of the interpeduncular and prepontine cisterns, as well as safely remove and install a ventricular catheter with minimal trauma to surrounding structures and achieve a shunt-independent state.

Keywords: Slit ventricle syndrome, endoscopic ventriculocysternostomy, obstructive hydrocephalus, semi-rigid needle-shaped neuroendoscope, aqueductoplasty, septostomy.

Download file:

  1. Bergsneider M, Miller C, Vespa PM, Hu X. Surgical management of adult hydrocephalus. Surgery of human cerebrum II, Part 2. Neurosurgery. 2008;62(Suppl 2):643-60.
  2. Thompson DNP. Hydrocephalus. Surg Oxf Int. 2009;27(3):130-4.
  3. Kahle KT, Kulkarni AV, Limbrick DD Jr, Warf BC. Hydrocephalus in children. Lancet. 2016;387(10020):788-99. Available from: S0140-6736(15)60694-8.
  4. Sivaganesan A, Krishnamurthy R, Deshdeepak S, Viswanathan C. Neuroimaging of ventriculoperitoneal shunt complications in children. Pediatr Radiol. 2012;42(9):1029-46.
  5. Xenos C, Sgouros S, Natarajan K, Walsh AR, Hockley A. Influence of shunt type on ventricular volume changes in children with hydrocephalus. J Neurosurg. 2003;98:277-83.
  6. Walker ML, Fried A, Petronio J. Diagnosis and treatment of the slit ventricle syndrome. Neurosurg Clin N Am. 1993;4(4):707-14.
  7. Allan R, Chaseling R. Subtemporal decompression for slit-ventricle syndrome: Successful outcome after dramatic change in intracranial pressure wave morphology. Report of two cases. J Neurosurg. 2004;101(Suppl 2): S214-S217.
  8. Chernov MF, Kamikawa S, Yamane F, Ishihara S, Hori T. Neurofiberscope-guided management of slit-ventricle syndrome due to shunt placement. J Neurosurg. 2005;102(Suppl 3):S260-S267.
  9. Di Rocco C, Massimi L, Tamburrini G. Shunts vs endoscopic third ventriculostomy in infants: Are there different types and/or rates of complications? A review. Childs Nerv Syst. 2006;22:1573-89.
  10. Singh I, Haris M, Husain M, Husain N, Rastogi M, Gupta RK. Role of endoscopic third ventriculostomy in patients with communicating hydrocephalus: An evaluation by MR ventriculography. Neurosurg Rev. 2008;31:319-25.
  11. da Silva LR, Cavalheiro S, Zymberg ST: Endoscopic aqueductoplasty in the treatment of aqueductal stenosis. Childs Nerv Syst. 2007;23:1263-8.
  12. Kirollos RW, Javadpour M, May P, Mallucci C. Endoscopic treatment of suprasellar and third ventricle-related arachnoid cysts. Childs Nerv Syst. 2001;17:713-8.
  13. Wu Y, Green NL, Wrensch MR, Zhao S, Gupta N. Ventriculoperitoneal shunt complication in California: 1990 to 2000. Neurosurgery. 2007;61(3):557-63.
  14. Danchin AA. Endoskopicheskaya venrtikulotsisternostomiya pry atrezii dna tret’ego zheludochka – metodika operativnogo lecheniya bol’nyh s okkluzionnoy gidrotsefaliey, oslozhnyonnoy disfunktsiey ventrikuloperitoneal‘nogo shunta [Endoscopic ventriculocysternostomy with atresia of the floor of the third ventricle is a surgical technique for patients with occlusive hydrocephalus complicated by ventriculoperitoneal shunt dysfunction]. Ukr J Min Invas Endosc Surg. 2009;13(2):3-13.
  15. Khan F, Shamim MS, Rehman A, Bari ME. Analysis of factors affecting ventriculoperitoneal shunt survival in pediatric patients. Childs Nerv Syst. 2013;29:791-802.
  16. Drake JM, Kestle JR, Tuli S. Cerebrospinal fluid shunt technology. Clin Neurosurg. 2000;47:336-45.
  17. Dickerman RD, McConathy WJ, Morgan J, Stevens QE, Jolley JT, Schneider Sб et al. Failure rate of frontal versus parietal approaches for proximal catheter placement in ventriculoperitoneal shunts: Revisited. J Clin Neurosci. 2005;12:781-3.
  18. Kestle JR, Drake JM, Cochrane DD, Milner R, Walker ML, Abbott R III, et al. Endoscopic Shunt Insertion Trial participants: Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: A multicenter randomized trial. J Neurosurg. 2003;98:284-90.
  19. Harris CA, Resau JH, Hudson EA, West RA, Moon C, Black ADб et al. Reduction of protein adsorption and macrophage and astrocyte adhesion on ventricular catheters by polyethylene glycol and N-acetyl-L-cysteine. J Biomed Mater Res. 2011;A98:425-33.
  20. Takahashi Y, Ohkura A, Hirohata M, Tokutomi T, Shigemori M. Ultrastructure of obstructive tissue in malfunctioning ventricular catheters without infection. Neurol Med Chir. 1998;38:399-404.
  21. Zheng J, Chen G, Xiao Q, Huang Y, Guo Y. Endoscopy in the treatment of slit ventricle syndrome. Experimental and Therapeutic Medicine. 2017;14(4):3381-6. Available from:
  22. Danchin AA, Tkachenko EV, Danchina AV. Yatrogennaya induktsiya ventrikulomegalii i posleduyushchaya endoskopicheskaya perforatsiya dna III zheludochka v khirurgicheskom lechenii shchelevidnogo ventrikulyarnogo sindroma [The iatrogenic induction of ventriculomegaly with next endoscopic third ventriculostomy in the surgery of adult slit ventricle syndrome]. Ukr J Min Invas Endosc Surg. 2010;14(1):5-11.
  23. Hader WJ, Walker RL, Myles ST, Hamilton M. Complications of endoscopic third ventriculostomy in previously shunted patients. Neurosurgery. 2008;63(Suppl 1):ONS168-ONS175.
  24. Butler WE, Khan SA. The application of controlled intracranial hypertension in slit ventricle syndrome patients with obstructive hydrocephalus and shunt malfunction. Pediatr Neurosurg. 2001;35:305-10.
  25. Feng H, Huang G, Liao X, Fu K, Tan H, Pu H, et al. Endoscopic third ventriculostomy in the management of obstructive hydrocephalus: An outcome analysis. J Neurosurg. 2004;100:626-33.
  26. Peretta P, Ragazzi P, Carlino CF, Gaglini P, Cinalli Gю The role of Ommaya reservoir and endoscopic third ventriculostomy in the management of post-hemorrhagic hydrocephalus of prematurity. Childs Nerv Syst. 2007;23:765-71.
  27. Rashid QT, Salat MS, Enam K, Kazim SF, Godil SS, Enam SA, et al. Time trends and age-related etiologies of pediatric hydrocephalus: Results of a groupwise analysis in a clinical cohort. Childs Nerv Syst. 2012;28:221-7.
  28. Reddy GK, Bollam P, Caldito G, Willis B, Guthikonda B, Nanda A. Ventriculoperitoneal shunt complications in hydrocephalus patients with intracranial tumors: An analysis of relevant risk factors. J Neurooncol. 2011;103:333-42.
  29. Tuli S, Drake J, Lawless J, Wigg M, Lamberti-Pasculli M. Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus. J Neurosurg. 2000;92:31-8.
  30. Oktem IS, Menkü A, Ozdemir A. When should ventriculoperitoneal shunt placement be performed in cases with myelomeningocele and hydrocephalus? Turk Neurosurg. 2008;18:387-91.

Authors' information:

Sufianov Albert Akramovich
Doctor of Medical Sciences, Full Professor, Head of the Department of Neurosurgery, I.M. Sechenov First Moscow State Medical University; Chief Medical Officer, Federal Center for Neurosurgery
Scopus: 6603558501
ORCID ID: 0000-0001-7580-0385
Author ID: 446102
SPIN: 1722-0448

Rustamov Rakhmonzhon Ravshanovich
Postgraduate Student, Department of Neurosurgery, I.M. Sechenov First Moscow State Medical University; Neurosurgeon, Federal Center for Neurosurgery
ORCID ID: 0000-0003-3619-820X
SPIN: 7311-9781

Yakimov Yuriy Alekseevich
Candidate of Medical Sciences, Associate Professor of the Department of Neurosurgery, I.M. Sechenov First Moscow State Medical University; Head of Neurosurgery Department № 1, Federal Center for Neurosurgery
Scopus: 6602436163
Researcher ID: A-5261-2018
ORCID ID: 0000-0001-6675-2051
Author ID: 744804
SPIN: 7835-6062

Sufianov Rinat Albertovich
Assistant of the Department of Neurosurgery, I.M. Sechenov First Moscow State Medical University; Neurosurgeon, Federal Center for Neurosurgery
ORCID ID: 0000-0003-4031-0540
Author ID: 792245
SPIN: 1204-2994

Abdulrahman Ali Alzahrani
Registrar of the Department of Neurosurgery, I.M. Sechenov First Moscow State Medical University
ORCID ID: 0000-0001-7913-5394

Louis A. Borba
Professor, Director of the Clinic for Neurosurgery, Evangelical School of Medicine, Federal University of Parana City
ORCID ID: 0000-0001-5185-5752

Luciano Mastronardi
Professor, Department of Neurosurgery, I.M. Sechenov First Moscow State Medical University, Professor of the Department of Neurosurgery, Hospital San Filippo Neri, Rome, Italy
ORCID ID: 0000-0003-0105-5786

Isam Alnur Balel
Registrar of the Department of Neurosurgery, I.M. Sechenov First Moscow State Medical University
ORCID ID: 0000-0001-7561-3934

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Rustamov Rakhmonzhon Ravshanovich
Postgraduate Student, Department of Neurosurgery, I.M. Sechenov First Moscow State Medical University; Neurosurgeon, Federal Center for Neurosurgery

625032, Russian Federation, Tyumen, 4 km of Chervishevsky Road, Building 5

Tel.: +7 (3452) 293717


Materials on the topic: