Ventricular access device versus ventriculosubgaleal shunt in post hemorrhagic hydrocephalus associated with prematurity

Objective. Post-hemorrhagic hydrocephalus (PHH) secondary to germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) continues to be a common problem affecting preterm neonates. Two different devices are used to treat hydrocephalus in preterm neonates under 2.5 kg: (1) ventricular access device (VAD) and (2) ventricular to subgaleal shunt (VSGS). We aim to determine the differences between VAD and VSGS in daily patient management and shunt requirement outcome in premature infants with PHH. Method. The medical records of 32 preterm neonates diagnosed with GMH-IVH with PHH treated with a VAD or VSGS were reviewed. The grade of GMH-IVH, need for CSF taps, complications, malfunctions, and need for permanent VP shunt placement were compared between VAD and VSGS groups. Results. All (16/16) VAD patients required daily taps while 4/16 VSGS patients required daily taps. The VAD group had one complication while the VSGS group had five complications. About 28.57% of the patients treated with a VSGS did not require a permanent VP shunt. Around 6.25% of the patients treated with a VAD did not require a permanent VP shunt. Conclusion. VSGS is an effective means of providing temporary continuous drainage of CSF in PHH with an acceptable complication rate. VSGS has many advantages that make it superior to VAD as a temporizing shunt.