Collapsed Ventricles

[Cath278]

Hi.I have IIH/PTC and had a VP shunt fitted in Dec last. It is working properly just not well enought.I still have an opening pressure of 32 and papilloedema bilaterally. I was to have a second Vp shunt fitted in the near future but it seems my ventricles have " collapsed" or closed.Can anyone explain what this actually means and the long term prognosis? At the moment I have been discharged to my local Dr, for pain managment? Any insight would be very much appreciated! Cath278

[Cath278]

Dear Dr. Chahine,thank you very much for your very informative reply.It helps explain why I have had such a hard time pinning down an answer.Re:"this is a controversial neurosurgical topic." And yes, a LP shunt has been hinted at but with all that I have read myself and with all the conversations I have had with my neurosurgoen it would really be the last  call. My own GP has since arranged a second consult with a new neurosurgeon.As he says, to make sure all the bases are covered.
Once again, thank you for taking the time to answer a difficult to explain question.It is much appreciated. Cath278.

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history and review your imaging, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information, though this is a neurosurgical topic somewhat beyond my area of expertise (neurology).

I am not entirely sure by what is meant by collapsed ventricles, but one possibility is what is often referred to as slit ventricle syndrome. This is a syndrome described initially as being characterized by small (thin) ventricles on imaging, in patients with persistent headaches, in the setting of a normally functioning shunt. However, different definitions exist, and this is a controversial neurosurgical topic, and differs somewhat in children compared to adults. In general, if the diagnosis is made, conservative management, with treatment of the headache and other symptoms, is often employed. Sometimes, other surgical techniques such as lumbar-peritoneal shunting and 3rd ventriculostomy are employed. If slit ventricles occur in the setting of a malfunctioning shunt, then shunt revision is often indicated.

Continued follow-up with your neurosurgeon is indicated; understanding the implications of the findings on your imaging is important.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.