Early Treatment of Posthemorrhagic Hydrocephalus in Low-Birth-Weight Infants with Valveless Ventriculoperitoneal Shunts

Abstract

The surgical treatment of posthemorrhagic hydrocephalus (PHH) in low-birth-weight infants (LBWI) is debated. In a few cases, hydrocephalus progresses rapidly and requires early drainage, but valves and ventriculostomy have a high rate of complications in the early phase. Temporary valveless shunt (VLS) is proposed as an alternative treatment of acute PHH in LBWI. Thirteen infants with PHH, weighing less than 2,000 g at birth, were treated with VLS, which was systematically converted into a valve-regulated shunt (VRS) after a few weeks; during the same period, 27 others were treated with VRS initially. The use of VLS presented significantly more shunt obstructions, but not more shunt infections, than VRS. Although placement of VLS was performed earlier, and in smaller babies than VRS, the outcome after a mean 9.1-year follow-up period was comparable in both groups, and only shunt infection was correlated with a poor outcome. We conclude that VLS is a valuable treatment of rapidly evolving PHH in LBWI.

Ventriculosubgaleal shunt procedure and its long-term outcomes in premature infants with post-hemorrhagic hydrocephalus

“…In the present study, infection rate was 8%, which was consistent with the literature data on VSGS. Moreover, our result was found to be considerably lower than the infection rates of other treatment methods reported in the literature [20–24]. …”

“…Rahman et al [19] reported no infection development after carrying out VSGS and VPS procedures on 15 premature infants with PHH and a birth weight below 1,500 g. Moreover, in the absence of VSGS treatment, the infection rate after early VPS treatment in premature infants with PHH was found to be increasing from 20 to 50% by Vinchon et al [20] and as 45.2% by Reinprecht et al [2]. Infection rates of other methods used in PHH treatment in large series in the literature are reported to be 15.9–16.4 [21] in subcutaneous reservoir method and 10–27% in EVD method [22].…”

A Survey on Current Practice in the Neurosurgical Management of Preterm Infants with Posthemorrhagic Hydrocephalus in Germany

“…20,21 EVD is, however, associated with a high risk of infection especially in preterm infants with an incompetent immune system. 5,10,12,22,23 Infants with meningitis are at a particularly high risk for later shunt dependence and disability. 10 As a result of the high risk of infection, EVD is not recommended routinely.…”

“…The indications for vp shunt surgery vary and are controversially discussed. 22 Important factors are indisputably head growth 2,10,11 and an increase in ventricular width 18,25 when punctures are discontinued or performed less frequently. It is interesting to note that CSF protein content rarely plays a role in a decision for or against definitive shunt placement although the efficacy of CSF reabsorption decisively depends on CSF protein levels.…”

Ventriculosubgaleal Shunting – A Strategy to Reduce the Incidence of Shunt Revisions and Slit Ventricles: An Institutional Experience and Review of the Literature

“…At present, the most common definitive treatment for these patients is VP shunting. Slit ventricles and multiple episodes of shunt failure are problematic in many infants and preterm neonates shunted for hydrocephalus [2,6]. Prematurity favors shunt infections due to presumed immature immune systems [7].…”