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

Slit ventricle syndrome (SVS) is a 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 diagnosis and management of SVS, providing insights into its benefits and limitations. A 6-year-old boy with a history of ventriculoperitoneal (VP) shunt placement at 11 months of age for communicating hydrocephalus presented with recurrent headaches, nausea, and vomiting. Imaging revealed small ventricles without signs of obstruction. Six months later, he was readmitted with worsening symptoms and again demonstrated small ventricles on MRI. To clarify the diagnosis and guide management, nICP monitoring using the Brain4Care device was performed. The waveform analysis suggested cerebrospinal fluid (CSF) overdrainage, with a P2/P1 ratio of 0.54 and time-to-peak (TTP) of 0.03 in the 45° position. Based on these findings, the shunt valve was revised to a fixed high-pressure setting. Postoperative nICP monitoring demonstrated normalized parameters (P2/P1 = 0.86 supine, 1.13 standing), and the patient remained asymptomatic. MRI confirmed normalization of ventricular size. This case highlights the utility of nICP monitoring in detecting overdrainage and guiding appropriate surgical management. The nICP monitoring may be a helpful tool for diagnosing and evaluating the type-specific SVS and guiding appropriate management. However, further investigations involving a larger number of patients are necessary to validate these findings.