Complications of ventriculosubgaleal shunts in infants and children

Tubbs, R. Shane; Banks, Jason T.; Soleau, Scott; Smyth, Matthew D.; Wellons, John C.; Blount, Jeffrey P.; Grabb, Paul A.; Oakes, W. Jerry

doi:10.1007/s00381-004-0967-6

Cited by 51 publications

(23 citation statements)

References 17 publications

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“…the peritoneum and pleura. Another study [19] done on 170 patients found that VSG shunts were associated with complications such as infection (5.9%), intracranial haemorrhage (1.1%) and wound leakage (4.7%). Another study [20] (n = 32) looked into VSG shunt survival and complications.…”

Section: Discussionmentioning

confidence: 99%

Ventriculosubgaleal Shunting for Post-Haemorrhagic Hydrocephalus in Premature Neonates

Rizvi

Wood²

2010

Pediatr Neurosurg

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Background: The management of hydrocephalus secondary to intraventricular haemorrhage in neonates can be controversial. Temporary diversion of cerebrospinal fluid (CSF) is often required due to the low birth weight and high risks of shunting in these patients. Ventriculosubgaleal (VSG) CSF diversion is an effective way of achieving this goal whilst minimising the risks of complications. It is a well-described technique but is rarely used in contemporary neurosurgical practice. Methods: Nine neonates treated with VSG shunting for post-haemorrhagic hydrocephalus were assessed. Gestational age, birth weight, duration of treatment efficacy, requirement for permanent shunting and complications were recorded. Results: In all 9 patients, the VSG shunt controlled the progression of hydrocephalus. A permanent shunt was avoided in 2 patients. One patient required revision of the subgaleal shunt to extend the interval to the insertion of a permanent shunt. None of the patients developed any CSF infection or leak. Conclusion: VSG CSF diversion offers a simple, effective and relatively safe means of treating hydrocephalus in the neonate, with a low risk of complications and the possibility of avoiding permanent shunting.

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Section: Discussionmentioning

confidence: 99%

Ventriculosubgaleal Shunting for Post-Haemorrhagic Hydrocephalus in Premature Neonates

Rizvi

Wood²

2010

Pediatr Neurosurg

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“…Several other treatment modalities have been used to address PHH, such as ventriculosubgaleal shunt (VSGS), endoscopic third ventriculostomy, external ventricular drainage or immediate shunting [4,5,10,19,20,21,22]. VSGSs are often appealing because they obviate the need for placing hardware that is notorious for its infection risk.…”

Section: Discussionmentioning

confidence: 99%

Ventricular Access Devices Are Safe and Effective in the Treatment of Posthemorrhagic Ventricular Dilatation prior to Shunt Placement

et al. 2012

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Intraventricular hemorrhage of prematurity (IVH) is a diagnosis that has become more frequent in recent years. Advances in medical care have led to survival of increasingly premature infants, as well as infants with more complex medical conditions. Treatment with a ventricular access device (VAD) was reported almost 3 decades ago; however, it is unclear how effective this treatment is in the current population of premature infants. At our institution (from 2004 to present), we treat posthemorrhagic hydrocephalus (PHH) with a VAD. In order to look at safety and efficacy, we retrospectively combed the medical records of premature children, admitted to Lucile Packard Children’s Hospital from January 2005 to December 2009, and identified 310 premature children with IVH. Of these, 28 children required treatment for PHH with a VAD. There were no infections associated with placement of these devices and a very low rate of other complications, such as need for repositioning (7.41%) or replacement (3.75%). Our data show that treatment with a VAD is very safe, with few complications and can be used to treat PHH in this very complex infant population.

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“…In our series, 6.5% of infants developed leaks, which is similar to that reported in other series. 9,20,28 We make a continual effort to reduce the incidence of leaks even further with such measures as emptying the subgaleal pocket prior to scalp closure, meticulous watertight skin closure, and avoidance of pressure on wounds by hats or respiratory devices.…”

Section: Specific Benefits and Risks Of The Vsgsmentioning

confidence: 99%

“…9,10,16,18,28 The severe neurological complications associated with IVH and PHH and the increasing survival rates of infants with extremely low birth weights necessitate a better understanding of the benefits and disadvantages associated with the reservoir and VSGS. In this study, a retrospective review of preterm infants treated for IVH and PHH at a single institution over a 14-year period was performed.…”

mentioning

confidence: 99%

Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate

Wang

Amin

Jallo

et al. 2014

PED

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Object The most common neurosurgical condition observed in preterm infants is intraventricular hemorrhage (IVH), which often results in posthemorrhagic hydrocephalus (PHH). These conditions portend an unfavorable prognosis; therefore, the potential for poor neurodevelopmental outcomes necessitates a better understanding of the comparative effectiveness of 2 temporary devices commonly used before the permanent insertion of a ventriculoperitoneal (VP) shunt: the ventricular reservoir and the ventriculosubgaleal shunt (VSGS). Methods The authors analyzed retrospectively collected information for 90 patients with IVH and PHH who were treated with insertion of a ventricular reservoir (n = 44) or VSGS (n = 46) at their institution over a 14-year period. Results The mean gestational age and weight at device insertion were lower for VSGS patients (30.1 ± 1.9 weeks, 1.12 ± 0.31 kg) than for reservoir patients (31.8 ± 2.9 weeks, 1.33 ± 0.37 kg; p = 0.002 and p = 0.004, respectively). Ventricular reservoir insertion was predictive of more CSF taps prior to VP shunt placement compared with VSGS placement (10 ± 8.7 taps vs 1.6 ± 1.7 taps, p < 0.001). VSGS patients experienced a longer time interval prior to VP shunt placement than reservoir patients (80.8 ± 67.5 days vs 48.8 ± 26.4 days, p = 0.012), which corresponded to VSGS patients gaining more weight by the time of shunt placement than reservoir patients (3.31 ± 2.0 kg vs 2.42 ± 0.63 kg, p = 0.016). Reservoir patients demonstrated a trend toward more positive CSF cultures compared with VSGS patients (n = 9 [20.5%] vs n = 5 [10.9%], p = 0.21). There were no significant differences in the rates of overt device infection requiring removal (reservoir, 6.8%; VSGS, 6.5%), VP shunt insertion (reservoir, 77.3%; VSGS, 76.1%), or early VP shunt infection (reservoir, 11.4%; VSGS, 13.0%) between the 2 cohorts. Conclusions Although the rates of VP shunt requirement and device infection were similar between patients treated with the reservoir versus the VSGS, VSGS patients were significantly older and had achieved greater weights at the time of VP shunt insertion. The authors' results suggest that the VSGS requires less labor-intensive management by ventricular tapping; the VSGS patients also attained higher weights and more optimal surgical candidacy at the time of VP shunt insertion. The potential differences in long-term developmental and neurological outcomes between VSGS and reservoir placement warrant further study.

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Complications of ventriculosubgaleal shunts in infants and children

Cited by 51 publications

References 17 publications

Ventriculosubgaleal Shunting for Post-Haemorrhagic Hydrocephalus in Premature Neonates

Ventriculosubgaleal Shunting for Post-Haemorrhagic Hydrocephalus in Premature Neonates

Ventricular Access Devices Are Safe and Effective in the Treatment of Posthemorrhagic Ventricular Dilatation prior to Shunt Placement

Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate

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