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Ventriculosubgaleal shunt: an institutional experience

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Abstract

Background and objective

Ventriculosubgaleal shunt (VSGS) was first described in 1896 by Von Mickulicz. It allows CSF to flow from the dilated ventricle to the subgaleal pouch developed in the scalp through a small silicon tube. The possibility that the hydrocephalic state in infants caused by hemorrhage/ + infection will only last a short while prompts the search for temporary management options, which must be a closed system in order to be more physiological given that these infants are frequently preterm (LBW) and immunologically immature. VSGS is one such option. To the best of our knowledge, most of the studies done on VSGS are retrospective, and there are very few prospective studies (none on Indian subjects till now). We aim to study the efficacy of VSGS in preventing the placement of VP Shunt in infants with post-hemorrhagic/post-infectious hydrocephalus.

Method

Our study (prospective observational) comprises 30 infants in whom VSGS was inserted at Sir Gangaram Hospital between August 2017 and October 2020 and who were followed up for 6 months after VSGS insertion.

Result

Most of the infants had a birth weight between 1501 and 2000 g with a mean gestational age of 31.2 weeks. Thirteen out of 30 patients did not require the placement of VP shunt. The rates were higher in the post-infectious group (50%) in contrary to the post hemorrhagic group where it was 38.8%. Complications encountered with VSGS include CSF leak (13.3%) and wound dehiscence (6.6%). None had VSGS blockage, migration, and infection.

Conclusion

We conclude that VSGS is a reliable, safe, easy to perform, and temporary treatment option in infants with post-hemorrhagic and post-infectious hydrocephalus and helps in avoiding VP shunt dependency in nearly half of them.

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Availability of data and materials

Any datasets used can be easily accessed. Please send an email to anurag.catch@gmail.com.

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Authors and Affiliations

  1. Department of Neurosurgery, Sir Ganga Ram Hospital, Room No. 1242A, 2nd Floor, Old Building, New Delhi, 110060, India

    Jain Anurag

  2. Department of Pediatric Neurosurgery, Sir Ganga Ram Hospital, New Delhi, India

    Chopra Sandeep & Sharma Arunav

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  1. Jain Anurag
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  2. Chopra Sandeep
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  3. Sharma Arunav
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Contributions

All the authors have equal contribution in the study.

Corresponding author

Correspondence to Jain Anurag.

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Ethical approval

A valid written informed consent was obtained from both the parents of all the patients being enrolled for the study after explaining the objectives and benefits of the study. The study was then undertaken after approval of the Ethics Committee, Sir Ganga Ram Hospital, New Delhi, India (EC/08/17/1237).

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No interests of a financial or personal nature.

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Key Message

In event of failure of most of the modalities of CSF diversion in treatment of post hemorrhagic and post infectious hydrocephalus in infants, subgaleal pouch may be resorted to.

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Anurag, J., Sandeep, C. & Arunav, S. Ventriculosubgaleal shunt: an institutional experience. Childs Nerv Syst 39, 2131–2137 (2023). https://doi.org/10.1007/s00381-023-05937-w

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  • DOI: https://doi.org/10.1007/s00381-023-05937-w

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