CRANIAL EXPANSION FOR SHUNT-INDUCED CRANIOSTENOSIS. CASE REPORT

Introduction Ventriculoperitoneal shunts are complicated by symptomatic slit ventricles in 1-5% of cases. A few patients with slit-ventricles develop shunt-induced craniostenosis, which causes increased intracranial pressure as the brain grows, and may be mis-interpreted as a primary shunt problem. Cranial vault expansion has been described previously to treat shunt-induced craniosynostosis, but there have been no reports to date of cranial expansion in resource-poor settings. Case presentation We report a three-month old child who underwent myelomeningocele repair and insertion of a ventriculoperitoneal shunt. When she was four years old, she developed symptoms of increased intracranial pressure, had a head circumference 8cm below normal, and skull radiographs demonstrated a beatencopper appearance. A cranial expansion operation was performed. Post-operatively, her symptoms of increased intracranial pressure resolved and did not recur. Follow-up two years later revealed normal developmental milestones, no symptoms of increased intracranial pressure, a head circumference 5.4cm greater than preoperatively, and improved radiologic findings. Conclusion Shunt-induced craniostenosis should be considered in children with symptomatic slit-ventricle syndrome. The diagnosis can be made with clinical and radiographic criteria, without intracranial pressure monitoring, in resource-poor settings, and treated effectively with cranial vault expansion.