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Child's Nervous System
Published in: Child's Nervous System 8/2023

01-04-2023 | Wound Dehiscence | Original Article

Ventriculosubgaleal shunt: an institutional experience

Authors: Jain Anurag, Chopra Sandeep, Sharma Arunav

Published in: Child's Nervous System | Issue 8/2023

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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.
Literature
1.
Aschoff A, Kremer P, Hashemi B, Kunze S (1999) The scientific history of hydrocephalus and its treatment. Neurosurg Rev 22:67–93CrossRefPubMed
2.
Cramer BC, Walsh EA (2001) Cisterna magna clot and subsequent post-hemorrhagic hydrocephalus. Pediatr Radiol 3:153–159CrossRef
3.
Rhodes TT, Edward WH, Saunders RL, Harbaugh RE, Little CL, Morgan LJ (1987) External ventricular drainage for initial treatment of neonatal posthemorrhagic hydrocephalus: surgical and neuro developmental outcome. Pediatr Neurosci 13:255–262CrossRefPubMed
4.
Mazzola CA, Choudhri AF, Auguste KI et al (2014) Pediatric hydrocephalus systematic review and evidence-based guidelines task force. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants. J Neurosurg Pediatr 14(Suppl 1):8–23CrossRefPubMed
5.
Brouwer AJ, Groenendaal F, van den Hoogen A et al (2007) Incidence of infections of ventricular reservoirs in the treatment of posthaemorrhagic ventricular dilatation: a retrospective study (1992–2003). Arch Dis Child Fetal Neonatal Ed 92(1):F41–F43CrossRefPubMed
6.
Gaskill SJ, Marlin AE, Rivera S (1988) The subcutaneous ventricular reservoir: an effective treatment for posthemorrhagic hydrocephalus. Childs Nerv Syst 4(5):291–295CrossRefPubMed
7.
Hudgins RJ, Boydston WR, Gilreath CL (1998) Treatment of posthemorrhagic hydrocephalus in the preterm infant with a ventricular access device. Pediatr Neurosurg 29(6):309–313CrossRefPubMed
8.
Kormanik K, Praca J, Garton HJ, Sarkar S (2010) Repeated tapping of ventricular reservoir in preterm infants with post-hemorrhagic ventricular dilatation does not increase the risk of reservoir infection. J Perinatol 30(3):218–221CrossRefPubMed
9.
Chatterjee S (2021) The leftover shunts - ventriculosubgaleal, and ventriculocholecystal shunts. Neurol India 69:S488–S494CrossRefPubMed
10.
Eid S, Iwanaga J, Oskouian RJ, Loukas M, Jerry Oakes W, Shane Tubbs R (2018) Ventriculosubgaleal shunting—a comprehensive review and over two-decade surgical experience. Childs Nerv Syst 34(9):1639–1642CrossRefPubMed
11.
Nagy A, Bognar L, Pataki I, Barta Z, Novak L (2013) Ventriculosubgaleal shunt in the treatment of posthemorrhagic and postinfectious hydrocephalus of premature infants. Childs Nerv Syst 29:413–418CrossRefPubMed
12.
Köksal V, Öktem S (2010) Ventriculosubgaleal shunt procedure and its long-term outcomes in premature infants with post-hemorrhagic hydrocephalus. Childs Nerv Syst 26:1505–1515CrossRefPubMedPubMedCentral
13.
Karas CS, Baig MN, Elton SW (2007) Ventriculosubgaleal shunts at Columbus Children’s Hospital: neurosurgical implant placement in the neonatal intensive care unit. J Neurosurg Pediatrics 107(Suppl 3):220–223CrossRef
14.
Sil K, Ghosh SK, Chatterjee S (2020) Ventriculo-subgaleal shunts broadening the horizons:an institutional experience. Childs Nerv Syst. Online ahead of print
15.
Fulmer BB, Grabb PA, Oakes WJ, Mapstone TB (2000) Neonatal ventriculosubgaleal shunts. Neurosurgery 47:80–84PubMed
16.
Syed Ali A (2010) Rizvi Martin Wood Ventriculosubgaleal shunting for post-haemorrhagic hydrocephalus in premature neonates. Pediatr Neurosurg 46:335–339CrossRef
17.
Willis BK, Kumar CR, Wylen EL, Nanda A (2005) Ventriculosubgaleal shunt for post hemorrhagic hydrocephalus in premature infants. Pediatr Neurosurg 41:178–185CrossRefPubMed
18.
Rahman S, Teo C, Morris W, Lao D, Boop FA (1995) Ventriculosubgaleal shunt: a treatment option for progressive post hemorrhagic hydrocephalus. Childs Nerv Syst 11:650–654CrossRefPubMed
19.
Andrea N, Laszlo B, Istvan P, Zoltan V, Laszlo N (2012) Ventriculosubgaleal shunt in the treatment of posthemorrhagic and postinfectious hydrocephalus of premature infants. Childs Nerv Syst 29:413–418
20.
Limbrick DD Jr, Mathur A, Johnston JM, Munro R, Sagar J, Inder T, Park TS, Leonard JL, Smyth MD (2010) Neurosurgical treatment of progressive posthemorrhagic ventricular dilatation in preterm infants:a 10-year single-institution study. J NeurosurgPediatr 6:224–230
Metadata
Title
Ventriculosubgaleal shunt: an institutional experience
Authors
Jain Anurag
Chopra Sandeep
Sharma Arunav
Publication date
01-04-2023
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 8/2023
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-023-05937-w

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