Subgaleal shunting: A 20-year experience

Savitz, Martin H.; Malis, Leonard I.

doi:10.3171/foc.2000.9.6.11

Cited by 13 publications

(6 citation statements)

References 9 publications

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“…27 Some investigators have reported the avoidance of VP shunting in 20% of 23 patients following VSGS, but again, this outcome was influenced by multiple factors, including treatment selection criteria as discussed above. 8,22,25,26 An early HCRN retrospective cohort study designed to evaluate historical conversion of VRs and VSGSs to a permanent shunt across the network included 147 infants who underwent surgical intervention for PHH. Of these, 127 (86%) were initially treated using a temporizing mecha-nism (VR or VSGS) with 20 (14%) treated initially with a permanent CSF shunt.…”

Section: Discussionmentioning

confidence: 99%

“…Several single-center series report the incidence of shunt placement in these children using either subcutaneous reservoirs for intermittent percutaneous removal of CSF or ventriculosubgaleal shunt (VSGS) placement. 3,[6][7][8][9]11,16,17,19,22,23,[25][26][27] Two recent notable publications report the retrospectively reviewed single-center experience using both. 14,28 In 2009, the Hydrocephalus Clinical Research Network (HCRN) published an initial paper in which the permanent shunt rates were evaluated in a 147-patient retrospective nonstandardized cohort.…”

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confidence: 99%

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Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study

Wellons

Shannon

Holubkov³

et al. 2017

Journal of Neurosurgery: Pediatrics

112

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OBJECTIVEPrevious Hydrocephalus Clinical Research Network (HCRN) retrospective studies have shown a 15% difference in rates of conversion to permanent shunts with the use of ventriculosubgaleal shunts (VSGSs) versus ventricular reservoirs (VRs) as temporization procedures in the treatment of hydrocephalus due to high-grade intraventricular hemorrhage (IVH) of prematurity. Further research in the same study line revealed a strong influence of center-specific decision-making on shunt outcomes. The primary goal of this prospective study was to standardize decision-making across centers to determine true procedural superiority, if any, of VSGS versus VR as a temporization procedure in high-grade IVH of prematurity.METHODSThe HCRN conducted a prospective cohort study across 6 centers with an approximate 1.5- to 3-year accrual period (depending on center) followed by 6 months of follow-up. Infants with premature birth, who weighed less than 1500 g, had Grade 3 or 4 IVH of prematurity, and had more than 72 hours of life expectancy were included in the study. Based on a priori consensus, decisions were standardized regarding the timing of initial surgical treatment, upfront shunt versus temporization procedure (VR or VSGS), and when to convert a VR or VSGS to a permanent shunt. Physical examination assessment and surgical technique were also standardized. The primary outcome was the proportion of infants who underwent conversion to a permanent shunt. The major secondary outcomes of interest included infection and other complication rates.RESULTSOne hundred forty-five premature infants were enrolled and met criteria for analysis. Using the standardized decision rubrics, 28 infants never reached the threshold for treatment, 11 initially received permanent shunts, 4 were initially treated with endoscopic third ventriculostomy (ETV), and 102 underwent a temporization procedure (36 with VSGSs and 66 with VRs). The 2 temporization cohorts were similar in terms of sex, race, IVH grade, head (orbitofrontal) circumference, and ventricular size at temporization. There were statistically significant differences noted between groups in gestational age, birth weight, and bilaterality of clot burden that were controlled for in post hoc analysis. By Kaplan-Meier analysis, the 180-day rates of conversion to permanent shunts were 63.5% for VSGS and 74.0% for VR (p = 0.36, log-rank test). The infection rate for VSGS was 14% (5/36) and for VR was 17% (11/66; p = 0.71). The overall compliance rate with the standardized decision rubrics was noted to be 90% for all surgeons.CONCLUSIONSA standardized protocol was instituted across all centers of the HCRN. Compliance was high. Choice of temporization techniques in premature infants with IVH does not appear to influence rates of conversion to permanent ventricular CSF diversion. Once management decisions and surgical techniques are standardized across HCRN sites, thus minimizing center effect, the observed difference in conversion rates between VSGSs and VRs is mitigated.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study

Wellons

Shannon

Holubkov³

et al. 2017

Journal of Neurosurgery: Pediatrics

112

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“…The early surgical records do not indicate that Cushing attempted a ventriculosubgaleal shunt for temporary CSF diversion; however, contemporary neurosurgeons frequently employ these shunts as temporizing measures for hydrocephalus secondary to trauma [8,9], or in premature neonates for treatment of post-hemorrhagic hydrocephalus [10,11]. …”

Section: Discussionmentioning

confidence: 99%

Harvey Cushing's early management of hydrocephalus: An historical picture of the conundrum of hydrocephalus until modern shunts after WWII

Chesler¹,

Pendleton²,

Ahn³

et al. 2013

Clinical Neurology and Neurosurgery

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Purpose Throughout his early career, Cushing proposed a variety of methods for temporary and permanent drainage and diversion of CSF in his patients, and acknowledged that certain techniques were more suited to particular subsets of hydrocephalus. Methods Following IRB approval, and through the courtesy of the Alan Mason Chesney Archives, the surgical records of the Johns Hopkins Hospital, from 1896 to 1912, were reviewed. Patients operated upon by Harvey Cushing were selected for further analysis. Within this cohort, we recovered all available records for a single patient with hydrocephalus and spina bifida, who was treated with a ventriculosubgaleal shunt prior to repair of the spina bifida. Results A 3 month-old infant presented with hydrocephalus associated with spina bifida. Cushing performed serial lumbar and ventricular punctures. Following this, Cushing took the patient to the operating room for placement of a ventriculosubgaleal shunt. The patient subsequently underwent excision of the myelomeningocele sac, with post-operative mortality due to unspecified causes. Conclusions Cushing’s publications document a preference for translumbar-peritoneal drainage in patients with congenital hydrocephalus, particularly those with spina bifida. Although the placement of ventriculosubgaleal shunts has become an accepted practice for contemporary neurosurgeons, this case illustrates the challenges that early neurosurgeons faced in developing operative approaches for the treatment of congenital hydrocephalus.

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“…10,13 More recently, another team proposed subgaleal drainage for the treatment of acute subdural hemorrhage in 8 infants. 7 These authors successfully infused streptokinase into the subdural space over 3 days, followed by drainage of the subdural collection in the subgaleal space.…”

Section: Discussionmentioning

confidence: 99%

Subdural to subgaleal shunts: alternative treatment in infants with nonaccidental traumatic brain injury?

Blauwblomme

Rocco

Bourgeois

et al. 2015

PED

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OBJECT The ideal treatment for subdural hematomas (SDHs) in infants remains debated. The aim of this study was to analyze the safety and efficiency of subduro-subgaleal drainage in SDH. METHODS The authors conducted a single-center open-label study between August 2011 and May 2012. Data were prospectively collected in a database and retrospectively analyzed. RESULTS Eighteen patients (male/female ratio 1.25) with a median age of 5 months were surgically treated. All had preoperative symptoms of intracranial hypertension or seizures. The SDH was bilateral in 16 cases, with a median width of 12 mm. Success of the procedure was noted in 14 of the 18 patients. There was no intraoperative complication or postoperative infection. Drainage failure was attributable to suboptimal positioning of the subdural drain in 2 cases and to migration in 1 case. CONCLUSIONS Subduro-subgaleal drainage is an efficient treatment that could be proposed as an alternative to external subdural drainage or subduroperitoneal drainage.

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Subgaleal shunting: A 20-year experience

Cited by 13 publications

References 9 publications

Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study

Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study

Harvey Cushing's early management of hydrocephalus: An historical picture of the conundrum of hydrocephalus until modern shunts after WWII

Subdural to subgaleal shunts: alternative treatment in infants with nonaccidental traumatic brain injury?

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