Ventriculo-subgaleal shunt in the management of postinfective hydrocephalus

Kariyattil, Rajeev; Pillai, Ashok; Panikar, Dilip
July 2007
Journal of Pediatric Neurosciences;Jul-Dec2007, Vol. 2 Issue 2, p101
Academic Journal
INTRODUCTION: Ventriculo-subgaleal(VSG) shunts have proved to be useful in the management of post-hemorrhagic hydrocephalus especially in the neonate. However its role in infective hydrocephalus has not been commonly reported. AIM: To evaluate the short and long-term efficacy of VSG shunts in the management of post-infective hydrocephalus. Materials and Methods: Hospital records of 18 children who underwent VSG shunts at AIMS, Cochin between January 2003 and December 2006 were retrieved and the data analyzed retrospectively and entered on a spreadsheet. Short-term efficacy was based on assessment of control of infection and intracranial pressure and longterm efficacy on neuro-developmental assessment. RESULTS: The 18 children were between 1 month and 7 years (mean: 10 months), 4 (22%) of whom were born preterm. 7 (38.8%) had undergone previous procedures for hydrocephalus, of which 5 were ventriculoperitoneal (VP) shunts, 1 was endoscopic 3rd ventriculostomy and 1 reservoir placement. CSF culture just before or during VSG shunt was positive in 9 (50%). A repeat VSG was required in 5 (27.7%). Conversion to VP shunt was required in 14 (77.7%) with an interval of 1 to 3 months. Of the remaining, 2 died, one remains in a moribund state and one is stable without any shunt. There were 2 (11%) procedure related complications including one shunt migration and one wound infection. Follow-up ranged from 3 months to 4 years (mean: 20 months). A good neuro-developmental outcome was achieved in 10 (55.5%), fair in 2 (11%), poor in 4 (22%) with 2 (11%) deaths. Poor outcome was associated with wound infection (1) and multi-loculated hydrocephalus (3). Mortality was associated with severe congenital heart disease (1) and septicemia (1). CONCLUSION: VSG shunts are a safe, cost-effective and low-maintenance way of managing post-infective hydrocephalus in children.


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