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Ventriculosubgaleal shunt as a proposed technique for post-infectious hydrocephalus
Mohamed Mohsen Amen1, Ahmed Zaher2, Hatem Ibraheem Badr2
1Neurosurgery Department, Mansoura University, Mansoura, Egypt. dr.mo.mohsen@gmail.com.
Insights
Ventriculosubgaleal shunt (VSGS) is a safe and effective temporary procedure for infants with post-infectious hydrocephalus (PIH). This method helps manage cerebrospinal fluid (CSF) and reduces hospital stays before permanent shunting.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Medical Devices
Background:
- Post-infectious hydrocephalus (PIH) management is challenging, often requiring temporary cerebrospinal fluid (CSF) diversion.
- Ventriculosubgaleal shunt (VSGS) is used for post-hemorrhagic hydrocephalus (PHH) but its role in PIH is less understood.
Purpose of the Study:
- To evaluate the safety and efficacy of VSGS as a temporary CSF diversion in PIH patients.
- To determine the outcomes and complications associated with VSGS in this population.
Main Methods:
- Retrospective analysis of 50 consecutive pediatric cases undergoing VSGS for PIH.
- Data collected on patient demographics, hydrocephalus causes, shunt complications, and outcomes.
Main Results:
- Hydrocephalus arrested in 20% of patients; 72% required permanent diversion within 35 days.
- Complications included scalp infection, tissue breakdown, shunt exposure (20%), CSF leakage (24%), and shunt migration (4%).
- Mortality occurred in 8% due to sepsis; younger age, lower weight, male gender, and meningitis/ventriculitis were risk factors.
Conclusions:
- VSGS is a safe and effective temporary measure for infants with PIH awaiting definitive ventriculoperitoneal shunts (VPS).
- VSGS can potentially shorten hospital stays and reduce healthcare costs.
Background:
The management of post-infectious hydrocephalus (PIH) remains challenging for neurosurgeons. It requires a temporary diversion procedure till the normalization of CSF parameters prior to the permanent one. Ventriculosubgaleal shunt (VSGS) was widely used in pediatric cases with post-hemorrhagic hydrocephalus (PHH). However, its role in PIH is still lacking. This study was done to elucidate the safety and efficacy of VSGS as a temporary CSF diversion procedure before the permanent one in patients with PIH.
Patients And Methods:
This retrospective investigation analyzed the data of 50 consecutive cases who underwent VSGS for PIH.
Results:
The age of the included patients ranged between 1 and 10 months. Twenty-six cases had meningitis and or ventriculitis (52%), while the remaining had shunt infection. At follow-up, arresting of hydrocephalus was noted in ten patients (20%), while another 36 cases required the permanent diversion procedure within 35 days. Regarding the shunt complications, scalp infection, tissue breakdown, and shunt exposure were encountered in ten cases (20%), while CSF leakage was noted in 12 cases (24%). Shunt migration was noted in only two patients (4%). Shunt revision was needed in 16 cases (32%). Mortality was encountered in four cases (8%) because of sepsis. Risk factors for morbimortality included younger age, lower weight, male gender, and meningitis and or ventriculitis.
Conclusion:
VSGS is a safe and effective procedure in infants awaiting definitive VPS for postinfectious hydrocephalus. It was proven that VSGS has shortened the hospital stay and the economic burden on the country.
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