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  • Ventriculosubgaleal Shunts in Premature Infants with IVH: Institutional Experience Over 15 Years

    Final Number:
    659

    Authors:
    Esther Dupepe MD; Kathrin Zimmerman; Spenser Hayward; Samuel McClugage MD; Elizabeth Kuhn MD; Anastasia A Arynchyna MPH; Curtis J. Rozzelle MD; James M. Johnston MD; Brandon George Rocque MD, MS; Jeffrey P. Blount MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: The purpose of this project was to describe our population of premature infants and their initial surgical treatment of CSF diversion, specifically looking at complications.

    Methods: A retrospective chart review of premature infants with grade III/IV intraventricular hemorrhage who underwent temporization procedure (VSGS) between 2003-2014 was performed. Data points collected included birth information and initial temporary CSF diversion. SPSS (V25) was used for statistical analysis.

    Results: We identified a final cohort of 121 premature infants. The cohort is characterized by the following: female (52%), African American (52%), Medicaid (72%), BW (887±335g), ELBW (<1,000g; 72%), gestational age (25.75±2.5 weeks, range 22-36), and Grave IV IVH (60%). Analysis showed that only 8% had CSF leak from VSGS which can be explained by head circumference percentile being in the lower range at VSGS placement (42%±27%, median 39%, n=51). However, 46% required VSGS revision and 34% of them were due to infection. 86% of patients subsequently required permanent CSF diversion (ETV/Shunt): 81% received VP shunt and 6% received ETV. Out of those who received VP shunt, 27% had 1 shunt revision, 21% had 2 revisions, and 22% had 3-9 revisions.

    Conclusions: Our experience shows that VSGS is an appropriate surgical technique for premature infants with intraventricular hemorrhage. Rates of leaks and infections are relatively low. Some patients can be temporized with VSGS without need for permanent CSF diversion.

    Patient Care: If VSGS use is more widespread as the initial CSF diversion procedure, some premature infants may avoid placement of permanent ventriculoperitoneal shunt and the associated morbidity.

    Learning Objectives: 1. We observed low rates of complications for VSGS in premature infants 2. Only 86% of patients initially requiring treatment with CSF diversion required definitive surgery permanent diversion.

    References:

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