Related Experiment Video
Updated: Jul 18, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Treatment of posthemorrhagic hydrocephalus in the preterm infant with a ventricular access device
R J Hudgins1, W R Boydston, C L Gilreath
1Department of Neurosurgery, Scottish Rite Children's Medical Center, Atlanta, Ga., USA. rogerhud@aol.com
Insights
The ventricular access device (VAD) offers an effective treatment for posthemorrhagic hydrocephalus (PHH) in preterm infants, managing intracranial pressure with acceptable complication rates. This method provides a viable option for controlling PHH when ideal treatments are unavailable.
Area of Science:
- Neonatalogy
- Pediatric Neurosurgery
- Critical Care Medicine
Background:
- Intraventricular hemorrhage (IVH) and posthemorrhagic hydrocephalus (PHH) are common complications in extremely preterm infants.
- Current treatment methods for PHH are not ideal, necessitating exploration of alternative approaches.
Purpose of the Study:
- To evaluate the efficacy and safety of the ventricular access device (VAD) as a treatment modality for PHH in a large cohort of preterm infants.
- To analyze complication rates, including infection, malfunction, and wound issues, associated with VAD use.
Main Methods:
- A retrospective review of 149 preterm infants with PHH treated with VAD placement and serial taps.
- Data collected included infant demographics, IVH grade, VAD-related complications, and outcomes such as shunt placement or VAD removal.
- Complications analyzed included VAD occlusion, trapped ventricles, infection, and wound problems.
Main Results:
- VAD occlusion occurred in 10% of infants, and 8% experienced VAD infection, with some infections treated conservatively.
- Revision rates due to occlusion, trapped ventricles, or infection were 20%.
- For survivors, 88% ultimately required shunt placement, with minimal wound complications reported.
Conclusions:
- The ventricular access device (VAD) is a valuable treatment option for posthemorrhagic hydrocephalus (PHH) in preterm infants, offering manageable complication rates.
- VAD management is feasible for extended periods and can be performed with minimal disruption, facilitating medication administration.
- While not ideal, the VAD provides a crucial therapeutic intervention for PHH when other options are limited.
Abstract:
Intraventricular hemorrhage (IVH) and subsequent posthemorrhagic hydrocephalus (PHH) commonly complicate the course of extremely preterm infants. Many methods for treating the hydrocephalus have been used, none of which are ideal. We present the largest series of infants with PHH treated with one modality, the ventricular access device (VAD). One hundred and forty-nine preterm infants with PHH were treated by placement of a VAD and serial taps to control intracranial pressure and ventricular size. Variables recorded include gender, race, gestational age, weight at birth, IVH grade, incidence of VAD infection, malfunction or local wound problems and indwelling time to either shunt placement or VAD removal. Of the 149 preterm infants, 91 were males and 58 females. The average birth weight was 994 g and the average gestational age at birth was 26.3 weeks. Three infants were IVH grade 1, 8 were grade 2, 62 were grade 3 and 76 were grade 4. VAD occlusion occurred in 15 infants (10%). Nine infants required contralateral VAD placement for a trapped ventricle. VAD infection occurred in 12 infants (8%), 5 of whom were treated successfully with a combination of systemic and intra-VAD antibiotics without removal of the VAD. The total rate of revision was thus 20% (15 for occlusion, 9 for trapped ventricle, 7 for infection). Wound problems were minimal and consisted of 4 cerebrospinal fluid leaks and 14 subgaleal fluid collections. For the 133 survivors, the rate of shunt placement was 88%. The VAD, while not ideal, is an excellent treatment at this time for PHH. It can be utilized for several months with acceptable rates of infection, blockage and wound complications. The VAD tap is simple to perform, not disruptive to minimal stimulation protocols, and can be done by physician extenders. In addition, medications can be administered via the access device, thus allowing treatment of some infections without VAD removal as well as instillation of thrombolytic agents such as urokinase.
