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Updated: Aug 5, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Prolonged puncturing decreases ventriculoperitoneal shunt insertion rate in neonates with posthemorrhagic ventricular
Dino Gačević1, Gerbrich E van den Bosch2, Ronny Knol2
1Department of Neurosurgery, Erasmus Medical Center, Dr. Molenwaterplein 40, 3015 GD, Rotterdam, the Netherlands.
Insights
Extending ventricular access device (VAD) punctures beyond 28 days for preterm infants with posthemorrhagic ventricular dilatation (PHVD) significantly reduced the need for ventriculoperitoneal shunt (VPS) insertion, offering a less invasive approach.
Area of Science:
- Neonatal Neurology
- Pediatric Neurosurgery
- Clinical Pediatrics
Background:
- Posthemorrhagic ventricular dilatation (PHVD) is a common complication in preterm infants following intraventricular hemorrhage (IVH).
- PHVD is linked to adverse neurodevelopmental outcomes.
- Current Dutch guidelines recommend up to 28 days of ventricular access device (VAD) punctures before considering a ventriculoperitoneal shunt (VPS).
Purpose of the Study:
- To evaluate if extending VAD punctures beyond 28 days impacts the final VPS insertion rate in infants with PHVD.
- To assess the efficacy of prolonged temporizing management for PHVD.
Main Methods:
- A retrospective single-center cohort study was conducted at Erasmus MC-Sophia Children's hospital.
- Included patients were born between 2010 and 2020 and treated for PHVD.
- Data on VAD puncture duration and VPS insertion were analyzed.
Main Results:
- Out of 55 infants with PHVD, 23 underwent VAD punctures for longer than 28 days.
- Only 14 of these infants ultimately required VPS insertion.
- This strategy resulted in a significant 15% reduction in the final VPS insertion rate (p < 0.001).
Conclusions:
- Prolonging VAD punctures beyond 28 days for select infants with PHVD and a favorable clinical course can decrease the rate of VPS insertion.
- This approach offers a less invasive temporizing measure.
- Further research is needed to explore the optimal duration and impact of extended punctures.
Purpose:
Posthemorrhagic ventricular dilatation (PHVD) is a frequent complication of intraventricular hemorrhage (IVH) in preterm infants and is associated with increased neurodevelopmental morbidity. Following national Dutch guidelines, infants with PHVD are generally punctured for up to 28 days via a ventricular access device (VAD), before a ventriculoperitoneal shunt (VPS) is inserted. We aimed to investigate retrospectively whether performing VAD punctures for longer than 28 days decreased the final VPS insertion rate.
Methods:
Retrospective single-center cohort study at the Erasmus MC-Sophia Children's hospital in Rotterdam, the Netherlands. Patients were included if they were born between 2010 and 2020 and treated for PHVD.
Results:
Out of 55 included patients, 23 were punctured in low frequency longer than 28 days via their VAD because of improved but persistent ventricular dilatation. Only 14 of them ultimately did require VPS insertion, resulting in a significant reduction of 15% in the final VPS insertion rate (p < 0.001).
Conclusion:
Puncturing infants with PHVD with a beneficial clinical course via a VAD for longer than 28 days decreases the ventriculoperitoneal shunt insertion rate. Further research on prolonging temporizing punctures and its impact is warranted.
