Result and technnical note for ventriculosubgaleal shunting (VSGS) in prematures who suffered grades III and IV periventricular hemorrhage and hipertensive hydrocephalus

Introduction: Posthemorrhagic hydrocephalus comprises the most common complication in those premature neonates whose suffered germinative matrix hemorrhage, and its treatment is still matter of controversies. These infants usually weight less than 1,500 g and a temporary CSF diversion device is needed. This paper depicts the initial 17 cases of ventriculosubgaleal shunting (VSGS) in prematures who suffered grades III and IV periventricular hemorrhage and hipertensive hydrocephalus.

Methods: Our technique consists of subgaeal valveless shunt. We analyzed a series of 17 preterm infants who underwent VSGS for posthemorrhagic hydrocephalus between July 2015 and November 2017. The median gestation age was 28 weeks (range 23–32). The median weight was 890 grams (range 625–1,615). The mean span of time harboring de VSGS was 59,3 days (range 39–78).

Results: The cases were studied for: 1) revision of the system: 4 subjects (23,5%) had 2 system revisions each due to obstruction; 2) shunt related complications: 5 infants (29%) had positive CSF culture and the VSG converted to EVD and further VP shunt (2 of these showed previous CSF fistula through the wound); 4) convertion to VP shunt: 9 children (52,3%) showed persistent hydrocephalus at further investigation, and underwent to VP shunt after stable clinical condition and weight higher than 2,000 g. One death occurred in a very low birth weight subject who developed severe thrombocytopenia and pulmonary hemorrhage.

Conclusions: VSGS is a good alternative method to treat posthemorrhagic hydrocephalus, specially in preterm infant whose need a temporary shunt device. The low rate of severe complications and encouraging results about persistent hydrocephalus should guide further investigation and larger cases series.