Comparison of the use of ventricular access devices and ventriculosubgaleal shunts in posthaemorrhagic hydrocephalus: systematic review and meta-analysis

The literature search of five databases identified 338 publications, of which 5 met the inclusion criteria. All were retrospective cohort studies (evidence class 3b and 4). A significantly lower proportion of patients with a VSGS required CSF tapping compared to patients with a VAD (log OR −4.43, 95 % CI −6.14 to −2.72). No other significant differences between the VAD and VSGS were identified in their rates of infection (log OR 0.03, 95 % CI −0.77 to 0.84), obstruction (log OR 1.25, 95 % CI −0.21 to 2.71), ventriculoperitoneal shunt dependence (log OR −0.06, 95 % CI −0.93 to 0.82), subsequent shunt infection (log OR 0.23, 95 % CI −0.61 to 1.06), mortality (log OR 0.37, 95 % CI −0.95 to 1.70) or long-term disability (p = 0.9). In all studies, there was a lack of standardised criteria, variations between surgeons in heterogeneous cohorts of limited sample size and a lack of neurodevelopmental follow-up. This affirms the importance of an ongoing multicentre, prospective pilot study comparing these two temporising procedures to enable a more robust comparison.