Introduction: Ventriculosubgaleal shunts (VSGSs) are an established method of temporising hydrocephalus in neonates. They are associated with relatively high rates of CSF leak and infection. We evaluate a new technique in performing VSGS with a view to lowering complication rates.
Methods: Three infants underwent the new technique of VSGSs. A semicircle skin incision was made at the junction of the fontanelle and coronal suture on the right side. A proximal catheter attached to a rickham reservoir was placed into the lateral ventricle. Instead of undermining the galea of the entire scalp, a distal cathether was tunnelled to the contralateral side of the scalp where a Foley cather was also tunnelled, and a subgaleal pocket created by inflation of the balloon with 10ml saline.
Results: 2 patients has post haemorrhagic hydrocephalus, and the other had combined infectious and post haemorrhagic hydrocephalus. There was 0% CSF leak rate, and 0% blockage rate. None of the shunts required revision. 1 case where infection and haemorrhage were both present, weekly taps of the reservoir were carried out as head circumferences were increasing despite the VSGS. There was 0% infection/ secondary infection rate.
Conclusions: VSGS shunting is an effective temporising procedure in the management of hydrocephalus in infants. The new technique described promising in reducing CSF leak and infection, due to the fact that the subgaleal collection of CSF is distal to the wound, which therefore is not under any tension and healed well on all occasions. More large scale studies are needed to validate the technique.
Patient Care: Improve the treatment of hydrocephalus in neonates
Learning Objectives: A description of a new technique in Ventriculosubgaleal shunts with a lower associated complication rate.