Ventricular Access Devices Are Safe and Effective in the Treatment of Posthemorrhagic Ventricular Dilatation prior to Shunt Placement

Abstract

Intraventricular hemorrhage of prematurity (IVH) is a diagnosis that has become more frequent in recent years. Advances in medical care have led to survival of increasingly premature infants, as well as infants with more complex medical conditions. Treatment with a ventricular access device (VAD) was reported almost 3 decades ago; however, it is unclear how effective this treatment is in the current population of premature infants. At our institution (from 2004 to present), we treat posthemorrhagic hydrocephalus (PHH) with a VAD. In order to look at safety and efficacy, we retrospectively combed the medical records of premature children, admitted to Lucile Packard Children’s Hospital from January 2005 to December 2009, and identified 310 premature children with IVH. Of these, 28 children required treatment for PHH with a VAD. There were no infections associated with placement of these devices and a very low rate of other complications, such as need for repositioning (7.41%) or replacement (3.75%). Our data show that treatment with a VAD is very safe, with few complications and can be used to treat PHH in this very complex infant population.

Bedside placement of ventricular access devices under local anaesthesia in neonates with posthaemorrhagic hydrocephalus: preliminary experience

“…Their shunting rate is 95%. Notably, Tian et al [17] presented a series of VADs with a 0% infection rate, a very low complication rate and a tapping protocol quite similar to ours; nevertheless, they observed a shunt conversion rate of 70%. We were unable to identify factors that can explain the differences in outcome compared with our series.…”

“…Furthermore, there is no consensus on when to treat PHVD [3], and the optimum PHVD treatment remains unknown but may consist of temporising measures such as acetazolamide and furosemide [15], intraventricular fibrinolytic therapy [22], intermittent lumbar punctures, external ventricular drain (EVD), ventriculo-subgaleal shunting (VSGS), ventricular access devices (VAD) for intermittent CSF taps, neuroendoscopic lavage [4,6] and definitive measures such as ventriculo-peritoneal shunting (VPS) [12]. In a significant number of cases, temporising measures still led to persisting shunt dependency, although shunt dependency rates vary widely (5-95%), with the majority over 70% [1,2,4,6,10,11,13,14,17,[19][20][21]24].…”

Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate

“…While previous studies have demonstrated the advantages of placing a temporizing device rather than symptomatic management with serial ventricular taps before permanent VP shunt insertion, guidelines for the use of these devices have not been created. 26 The 2 mainstays are the ventricular reservoir and VSGS, which were compared in this study with respect to short-term outcomes including device infection and VP shunt insertion rates and timing.…”

The Cost of Serial Cerebrospinal Fluid Aspirations between Ventricular Access Device and Ventriculosubgaleal Shunt for Treatment of Posthemorrhagic Ventricular Dilatation in Premature Infants

“…Only one study that reported on VSGS mentioned labs, only that they were sent prior to VPS insertion [10]. For VADs, three studies explicitly stated that labs were sent after every aspiration [6,11,12], one study stated that "clinical investigations followed the punctures" [13], three studies from two research groups merely stated that labs were done "routinely" [14][15][16], one study "three times per week" [17], one study "at least once a week" [18], two studies "weekly" [19,20], one study "at 5-to 8-day intervals" [21], and one study just that labs were sent [22]. Assuming labs are obtained every 7 aspirations for institutions that obtain labs on a weekly basis for VADs, labs would be sent at least 3.7 times per VAD patient.…”