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Ventriculosubgaleal shunt: a treatment option for progressive posthemorrhagic hydrocephalus
1Division of Pediatric Neurosurgery, Arkansas Children's Hospital, Little Rock 72202, USA.
Insights
Ventriculosubgaleal (VSG) shunts offer a safe and effective temporary treatment for progressive posthemorrhagic hydrocephalus in premature infants. This method provides excellent cerebrospinal fluid diversion without complications, potentially avoiding further intervention.
Area of Science:
- Neonatalogy
- Pediatric Neurosurgery
- Neurology
Background:
- Premature infants (<1500 g) have a high incidence (>45%) of intraventricular hemorrhage.
- Progressive posthemorrhagic hydrocephalus (PPHH) develops in 40% of these infants.
- Optimal treatment for PPHH in premature neonates remains controversial.
Purpose of the Study:
- To evaluate the safety and efficacy of Ventriculosubgaleal (VSG) shunts for temporary cerebrospinal fluid (CSF) diversion in premature infants with PPHH.
- To assess the complication rate and need for subsequent treatment after VSG shunt insertion.
Main Methods:
- Retrospective case series of 15 premature infants with PPHH treated with VSG shunts.
- VSG shunts were inserted for temporary CSF diversion.
- Infants were monitored for complications and need for conversion to Ventriculoperitoneal (VP) shunts.
Main Results:
- Excellent temporary CSF diversion was achieved in all 15 patients.
- No complications were reported following VSG shunt insertion.
- Three out of 15 patients (20%) did not require further treatment after initial VSG shunting.
Conclusions:
- Ventriculosubgaleal (VSG) shunting is a safe and effective temporary treatment option for premature infants suffering from PPHH.
- The procedure facilitates physiological CSF diversion and may obviate the need for permanent shunting in some cases.
- VSG shunting represents a viable alternative in the management of PPHH, particularly for low-birth-weight infants.
Abstract:
Among premature infants born at less than 1500 g, the incidence of intraventricular hemorrhage is greater than 45%. Of these, 40% will develop progressive posthemorrhagic hydrocephalus (PPHH). Optimum treatment remains controversial. Ventriculosubgaleal (VSG) shunts were first proposed as a means of temporarily diverting cerebrospinal fluid (CSF) in a more physiological manner for those infants less than 1500 g in weight who would not tolerate a ventriculoperitoneal (VP) shunt. The VSG shunt could then be converted into a VP shunt when the infant had gained the desired weight. Despite favourable reports, the procedure has not gained universal acceptance and is unknown to many neurosurgeons. The present authors report a series of 15 patients who had VSG shunts inserted with excellent temporary CSF diversion and no complications. Furthermore, 3 out of the 15 patients required no further treatment. We suggest that VSG shunting is a safe and effective means of treating the premature infant with PPHH.