Outcome of Ventriculosubgaleal Shunt in the Management of Infectious and Non-infectious Hydrocephalus in Pre-term Infants

Abstract

Background: Hydrocephalus in premature infants is an onerous disease. In such situations, choosing the best option for cerebrospinal fluid (CSF) diversion is difficult. Ventriculosubgaleal shunt is an effective method of temporary CSF diversion in such situations. In this retrospective study, we compare the outcome of ventriculosubgaleal shunt in premature infants with hydrocephalus of infectious and noninfectious etiology.

Materials and methods: All premature children with hydrocephalus secondary to various etiologies who underwent ventriculosubgaleal shunt were studied. The participants were grouped into two depending upon the etiology of hydrocephalus: Group 1 (infectious) and Group 2 (non-infectious). The primary outcome was a successful conversion to ventriculoperitoneal shunt (VPS) and the secondary outcome was mortality. Data were entered into statistical software SPSS version 16 and appropriate statistical analysis was performed to conclude any statistical significance between groups.

Results: The study included 16 infants among whom 9 were in the infectious group and 7 in the non-infectious group. Primary end point of conversion to VPS was achieved in 55.5% of patients in group 1 and 85.7% in group 2. The secondary end point, i.e., mortality was observed in 44.4% of patients in group 1 and 14.2% in group 2. The average duration during which this was achieved was 40 days (range 20-60 days) in group 1 and 25 days (range 20-30 days) in group 2.

Conclusion: Ventriculosubgaleal shunt is a safe and effective procedure in infants awaiting definitive VPS for hydrocephalus of infectious as well as noninfectious origin. There was no statistical difference in the rate of successful conversion to a permanent VPS from ventriculosubgaleal shunt in hydrocephalus of either etiologies. Complications and time for successful conversion were more in postmeningitic hydrocephalus.

Keywords: Hydrocephalus; premature infants; ventriculosubgaleal shunt.

Figure 1

Computed tomography of brain plain—showing pan ventricular dilatation of the ventricle of the brain. Left-sided ventricle is marginally more dilated than the right

Figure 2

Operative procedure of the child undergoing VPS. A and B—child is positioned with head turned to the right side. A curvilinear incision is marked at the level of the lateral edge of the anterior fontanelle. A skin flap is raised along the incision line. C—a spacious subgaleal pouch is created along the temporal and parieto-occipital region. D—the lateral end of the fontanelle is tapped with a ventricular catheter. Note the flow of the opalescent CSF into the sample bottle. E and F—the distal end of a peritoneal catheter is connected to a connector to prevent kinking at the edge of the fontanelle, and slit ends of the same are placed into the newly created subgaleal pouch

Figure 3

Postoperative day 3 shows a working ventriculosubgaleal shunt in an infant who underwent the procedure as a result of postmeningitic hydrocephalus

Figure 4

Collapsed CSF pouch in the patient shown earlier in Figure 3 after successful conversion of VSGS into VPS