title: Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate.
abstract: OBJECTIVE
  The most common neurosurgical condition observed in preterm infants is intraventricular hemorrhage (IVH), which often results in posthemorrhagic hydrocephalus (PHH). These conditions portend an unfavorable prognosis; therefore, the potential for poor neurodevelopmental outcomes necessitates a better understanding of the comparative effectiveness of 2 temporary devices commonly used before the permanent insertion of a ventriculoperitoneal (VP) shunt: the ventricular reservoir and the ventriculosubgaleal shunt (VSGS).
  
  
  METHODS
  The authors analyzed retrospectively collected information for 90 patients with IVH and PHH who were treated with insertion of a ventricular reservoir (n = 44) or VSGS (n = 46) at their institution over a 14-year period.
  
  
  RESULTS
  The mean gestational age and weight at device insertion were lower for VSGS patients (30.1 ± 1.9 weeks, 1.12 ± 0.31 kg) than for reservoir patients (31.8 ± 2.9 weeks, 1.33 ± 0.37 kg; p = 0.002 and p = 0.004, respectively). Ventricular reservoir insertion was predictive of more CSF taps prior to VP shunt placement compared with VSGS placement (10 ± 8.7 taps vs 1.6 ± 1.7 taps, p < 0.001). VSGS patients experienced a longer time interval prior to VP shunt placement than reservoir patients (80.8 ± 67.5 days vs 48.8 ± 26.4 days, p = 0.012), which corresponded to VSGS patients gaining more weight by the time of shunt placement than reservoir patients (3.31 ± 2.0 kg vs 2.42 ± 0.63 kg, p = 0.016). Reservoir patients demonstrated a trend toward more positive CSF cultures compared with VSGS patients (n = 9 [20.5%] vs n = 5 [10.9%], p = 0.21). There were no significant differences in the rates of overt device infection requiring removal (reservoir, 6.8%; VSGS, 6.5%), VP shunt insertion (reservoir, 77.3%; VSGS, 76.1%), or early VP shunt infection (reservoir, 11.4%; VSGS, 13.0%) between the 2 cohorts.
  
  
  CONCLUSIONS
  Although the rates of VP shunt requirement and device infection were similar between patients treated with the reservoir versus the VSGS, VSGS patients were significantly older and had achieved greater weights at the time of VP shunt insertion. The authors' results suggest that the VSGS requires less labor-intensive management by ventricular tapping; the VSGS patients also attained higher weights and more optimal surgical candidacy at the time of VP shunt insertion. The potential differences in long-term developmental and neurological outcomes between VSGS and reservoir placement warrant further study.
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and.
authors.forename: Joanna Y
authors.initials: JY
authors.lastname: Wang
authors.forename: Anubhav G
authors.initials: AG
authors.lastname: Amin
authors.forename: George I
authors.initials: GI
authors.lastname: Jallo
authors.forename: Edward S
authors.initials: ES
authors.lastname: Ahn
mesh_terms: D002543:Cerebral Hemorrhage / Q000150:complications*; D002552:Cerebral Ventricles; D005260:Female; D005865:Gestational Age; D006801:Humans; D006849:Hydrocephalus / Q000208:ethnology / Q000209:etiology* / Q000601:surgery*; D007223:Infant; D007235:Infant, Premature, Diseases / Q000208:ethnology / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D017287:Ventriculoperitoneal Shunt / Q000706:statistics & numerical data*
keywords: EGA = estimated gestational age; ICP = intracranial pressure; IVH = intraventricular hemorrhage; PHH = posthemorrhagic hydrocephalus; VP = ventriculoperitoneal; VSGS = ventriculosubgaleal shunt; intraventricular hemorrhage; posthemorrhagic hydrocephalus; ventricular reservoir; ventriculoperitoneal shunt; ventriculosubgaleal shunt