title: Ventriculosubgaleal shunting--a strategy to reduce the incidence of shunt revisions and slit ventricles: an institutional experience and review of the literature.
abstract: OBJECTIVE
  Slit ventricles and multiple episodes of shunt failure are problematic in many infants and preterm neonates shunted for hydrocephalus. We utilized ventriculosubgaleal (VSG) shunting as the initial neurosurgical intervention in neonates with hydrocephalus associated with intraventricular hemorrhage and infants with myelomeningocele.
  
  
  METHODS
  We conducted a chart review of 21 children initially treated with a VSG shunt between November 2002 and July 2009. Patient records and imaging studies were reviewed. Demographics, case data and clinical outcome were collected.
  
  
  RESULTS
  Five patients (27.8%) required a revision after conversion to a ventriculoperitoneal (VP) shunt. There were 9 cases of radiographic slit ventricles (45%). Average follow-up was 59.5 months (range 12-97 months). Average time interval to shunt conversion was 81.5 days. Two patients have not required conversion to a VP shunt (one with an 8-year follow-up). To date, none of these patients has required a subtemporal window or cranial vault expansion.
  
  
  CONCLUSIONS
  Based on our results, initial management of selected hydrocephalic infants with a VSG shunt may prove to be advantageous in the long run for these children as the number of shunt revisions and the incidence of slit ventricles are significantly less than those reported in the literature.
authors.affiliation: Department of Neurosurgery, University of Rochester Medical Center and Golisano Children's Hospital, Rochester, NY 14642, USA. anthony_petraglia@urmc.rochester.edu
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Petraglia
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Moravan
authors.forename: Vassilios G
authors.initials: VG
authors.lastname: Dimopoulos
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Silberstein
mesh_terms: D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology / Q000601:surgery*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D012086:Reoperation; D012189:Retrospective Studies; D056124:Slit Ventricle Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000379:methods