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Ventriculosubgaleal shunts in the management of neonatal post-haemorrhagic hydrocephalus: technical note

  • Technical Note
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A Correction to this article was published on 29 September 2023

This article has been updated

Abstract

Introduction

Germinal matrix / intraventricular haemorrhage (GMIVH) remains a significant complication of prematurity. The more severe grades are associated with parenchymal haemorrhagic infarction (PHI) and hydrocephalus. A temporising procedure is usually the first line in management of neonatal post-haemorrhagic hydrocephalus (nPHH) as the risk of failure of a permanent cerebrospinal fluid (CSF) diversion is higher in the early stage. Our choice of temporising procedure is a ventriculosubgaleal shunt (VSGS). In this technical note, we describe a modification in technique whereby the pocket of the VSGS is fashioned away from the surgical wound. This resulted in lower CSF leak and subsequent infection rates in our centre.

Methods

We conducted a retrospective analysis of all patients who underwent insertion of a VSGS between September 2014 and February 2023.

Results

Twenty children were included in our study with a mean gestational age of 31 weeks + 4 days. Post-operatively, 10% of patients did not need a tap, and 10%, 20%, 15%, 25% and 20% respectively had 1, 2, 3, 4 and 5 taps. Two patients experienced CSF leak from their wounds. In both these patients, the pocket was deemed too close to the wound. None of the patients without suspected pre-existing CNS infection at the time of insertion of VSGS had a subsequent VSGS-related infection. VSGS conversion to permanent ventriculoperitoneal shunts (VPS) was required in 15 (75%) of the patients with an average interval duration of 72 days. On reviewing the literature, the infection rate following VSGS is quoted up to 13.5%. In our own centre, 13 patients had undergone VSGS insertion between 2005 and 2013 with a 30.8% infection rate which seemed related to increased leak rates.

Conclusion

Our modified surgical approach seems to be effective in reducing the risk of infection, which we postulate is a direct result of reduction in the risk of leak from the surgical wound.

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Reference

  1. Blencowe H, Cousens S, Chou D et al (2013) Born Too Soon: The global epidemiology of 15 million preterm births. Reprod Health 10:S2. https://doi.org/10.1186/1742-4755-10-S1-S2

    Article  PubMed  PubMed Central  Google Scholar 

  2. Köksal N, Baytan B, Bayram Y, Nacarküçük E (2002) Risk factors for intraventricular haemorrhage in very low birth weight infants. Indian J Pediatr 69:561–564. https://doi.org/10.1007/BF02722677

    Article  PubMed  Google Scholar 

  3. Chen Q, Feng Z, Tan Q et al (2017) Post-hemorrhagic hydrocephalus: Recent advances and new therapeutic insights. J Neurol Sci 375:220–230. https://doi.org/10.1016/j.jns.2017.01.072

    Article  PubMed  Google Scholar 

  4. Ahn SY, Shim S-Y, Sung IK (2015) Intraventricular Hemorrhage and Post Hemorrhagic Hydrocephalus among Very-Low-Birth-Weight Infants in Korea. J Korean Med Sci 30:S52. https://doi.org/10.3346/jkms.2015.30.S1.S52

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bolisetty S, Dhawan A, Abdel-Latif M et al (2014) Intraventricular Hemorrhage and Neurodevelopmental Outcomes in Extreme Preterm Infants. Pediatrics 133:55–62. https://doi.org/10.1542/peds.2013-0372

    Article  PubMed  Google Scholar 

  6. Kazan S, Güra A, Uçar T et al (2005) Hydrocephalus after intraventricular hemorrhage in preterm and low–birth weight infants: analysis of associated risk factors for ventriculoperitoneal shunting. Surg Neurol 64:S77–S81. https://doi.org/10.1016/j.surneu.2005.07.035

    Article  PubMed  Google Scholar 

  7. Willis BK, Kumar CR, Wylen EL, Nanda A (2005) Ventriculosubgaleal Shunts for Posthemorrhagic Hydrocephalus in Premature Infants. Pediatr Neurosurg 41:178–185. https://doi.org/10.1159/000086558

    Article  PubMed  Google Scholar 

  8. Fountain DM, Chari A, Allen D, James G (2016) Comparison of the use of ventricular access devices and ventriculosubgaleal shunts in posthaemorrhagic hydrocephalus: systematic review and meta-analysis. Child’s Nerv Syst 32:259–267. https://doi.org/10.1007/s00381-015-2951-8

    Article  Google Scholar 

  9. Robinson S (2012) Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts. J Neurosurg Pediatr 9:242–258. https://doi.org/10.3171/2011.12.PEDS11136

    Article  PubMed  Google Scholar 

  10. Mazzola CA, Choudhri AF, Auguste KI et al (2014) Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants. J Neurosurg Pediatr 14:8–23. https://doi.org/10.3171/2014.7.PEDS14322

    Article  Google Scholar 

  11. Frassanito P, Serrao F, Gallini F et al (2021) Ventriculosubgaleal shunt and neuroendoscopic lavage: refining the treatment algorithm of neonatal post-hemorrhagic hydrocephalus. Child’s Nerv Syst 37:3531–3540. https://doi.org/10.1007/s00381-021-05216-6

    Article  Google Scholar 

  12. Aschoff A, Kremer P, Hashemi B, Kunze S (1999) The scientific history of hydrocephalus and its treatment. Neurosurg Rev 22:67–93. https://doi.org/10.1007/s101430050035

    Article  CAS  Google Scholar 

  13. Savitz MH, Malis LI (2000) Subgaleal shunting: A 20-year experience. Neurosurg Focus 9:1–5. https://doi.org/10.3171/foc.2000.9.6.11

    Article  Google Scholar 

  14. Perret GE, Graf CJ (1977) Subgaleal shunt for temporary ventricle decompression and subdural drainage. J Neurosurg 47:590–595. https://doi.org/10.3171/jns.1977.47.4.0590

    Article  CAS  Google Scholar 

  15. Roland EH, Hill A (1997) Intraventricular hemorrhage and posthemorrhagic hydrocephalus. Current and potential future interventions. Clin Perinatol 24:589–605

    Article  CAS  PubMed  Google Scholar 

  16. Köksal V, Öktem S (2010) Ventriculosubgaleal shunt procedure and its long-term outcomes in premature infants with post-hemorrhagic hydrocephalus. Child’s Nerv Syst 26:1505–1515. https://doi.org/10.1007/s00381-010-1118-x

    Article  Google Scholar 

  17. Wellons JC, Shannon CN, Kulkarni AV et al (2009) A multicenter retrospective comparison of conversion from temporary to permanent cerebrospinal fluid diversion in very low birth weight infants with posthemorrhagic hydrocephalus. J Neurosurg Pediatr 4:50–55. https://doi.org/10.3171/2009.2.PEDS08400

    Article  PubMed  PubMed Central  Google Scholar 

  18. Alan N, Manjila S, Minich N et al (2012) Reduced ventricular shunt rate in very preterm infants with severe intraventricular hemorrhage: an institutional experience. J Neurosurg Pediatr 10:357–364. https://doi.org/10.3171/2012.7.PEDS11504

    Article  PubMed  Google Scholar 

  19. Ellenbogen JR, Waqar M, Pettorini B (2016) Management of post-haemorrhagic hydrocephalus in premature infants. J Clin Neurosci 31:30–34. https://doi.org/10.1016/j.jocn.2016.02.026

    Article  PubMed  Google Scholar 

  20. Limbrick DD, Mathur A, Johnston JM et al (2010) Neurosurgical treatment of progressive posthemorrhagic ventricular dilation in preterm infants: a 10-year single-institution study. J Neurosurg Pediatr 6:224–230. https://doi.org/10.3171/2010.5.PEDS1010

    Article  PubMed  Google Scholar 

  21. Nagy A, Bognar L, Pataki I et al (2013) Ventriculosubgaleal shunt in the treatment of posthemorrhagic and postinfectious hydrocephalus of premature infants. Child’s Nerv Syst 29:413–418. https://doi.org/10.1007/s00381-012-1968-5

    Article  Google Scholar 

  22. Petraglia AL, Moravan MJ, Dimopoulos VG, Silberstein HJ (2011) Ventriculosubgaleal Shunting – A Strategy to Reduce the Incidence of Shunt Revisions and Slit Ventricles: An Institutional Experience and Review of the Literature. Pediatr Neurosurg 47:99–107. https://doi.org/10.1159/000330539

    Article  Google Scholar 

  23. Rizvi SAA, Wood M (2010) Ventriculosubgaleal shunting for post-haemorrhagic hydrocephalus in premature neonates. Pediatr Neurosurg 46:335–9. https://doi.org/10.1159/000320135

    Article  Google Scholar 

  24. Fulmer BB, Grabb PA, Oakes WJ, Mapstone TB (2000) Neonatal Ventriculosubgaleal Shunts. Neurosurgery 47:80–84. https://doi.org/10.1097/00006123-200007000-00018

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK

    Cristina Bleil, Francesca Vitulli, Asfand Baig Mirza, Qusai Al Banna, Wisam AlFaiadh & Bassel Zebian

  2. Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II” University of Naples, Via Sergio Pansini n.5, 80131, Naples, Italy

    Francesca Vitulli

  3. GKT School of medicine, King’s College London, London, UK

    Timothy Martyn Boardman

Authors
  1. Cristina Bleil
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Contributions

Primary surgeon: Zebian, Bleil. Editing and drafting the video: Vitulli. Editing and drafting the manuscript: Vitulli, Mirza, Boardman, Al Banna, Al Faiadh. Critically revising the work: Zebian. Approved the final version of the work on behalf of all authors: Vitulli. Supervision: Zebian

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Correspondence to Francesca Vitulli.

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The original online version of this article was revised: In this article, “Miss” and “Mr” was captured as part of author given name. Given here is the corrected author names.

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Bleil, C., Vitulli, F., Mirza, A.B. et al. Ventriculosubgaleal shunts in the management of neonatal post-haemorrhagic hydrocephalus: technical note. Childs Nerv Syst 39, 3263–3271 (2023). https://doi.org/10.1007/s00381-023-06125-6

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