Context: Hydrocephalus, due to subarachnoid or intraventricular hemorrhage (IVH), meningitis,
or tumor compression, is usually transient and may resolve after treatment. There
are several temporary methods of cerebrospinal fluid (CSF) diversion, none of it is
superior to the other, and the decision is based on its various etiologies and factors.
Ventriculosubgaleal shunt (VSGS) is one of those temporary measures, which is a simple
and rapid CSF decompression method without causing electrolyte and nutritional losses.
Aims: The aim is to study the efficacy of VSGS for temporary CSF diversion, compared to
extraventricular drainage (EVD) in adult hydrocephalus patients; to evaluate the outcome
in terms of avoiding a permanent shunt, and to look for incidences of their complications.
Settings and Design: This was a retrospective observational study. Subjects and Methods:
The data were acquired from case notes of fifty patients with acute hydrocephalus:
26 secondary to IVH, 10 from aneurysm rupture, 8 posttrauma, and 6 from infection.
All these patients had undergone CSF diversion in Hospital Queen Elizabeth II, Sabah,
Malaysia, between 2013 and 2015. The patients were followed up from the date of treatment
until the resolution of hydrocephalus, where parameters such as shunt dependency and
complications were documented. Statistical Analysis Used: All analyses were carried
out using Statistical Packages for the Social Sciences Version 22.0. Chi-squared test
or Fisher's exact test is used for univariate analysis of categorical variables. Results: A total of 21 (42%) patients underwent EVD insertion and 29 (58%) underwent VSGS
insertion. Thirty-seven (74%) patients did not require a permanent shunt; 24 (64.8%)
of them were from the VSGS group (P = 0.097). EVD had more intracranial complications
(44.1%) compared with VSGS (23.5%), with a statistically significant P = 0.026. Conclusions: VSGS is a safe and viable option for adult hydrocephalus patients, with the possibility
of continuation of the treatment for such patients in nonneurosurgical centers, as
opposed to patients with EVDs. Furthermore, even though this method had no statistical
difference in avoiding a permanent ventriculoperitoneal shunt, VSGS has statistically
significant less intracranial complications compared with EVD.
Key-words:
Cerebrospinal fluid diversion - extraventricular drainage - hydrocephalus - permanent
shunt - ventriculoperitoneal shunt - ventriculosubgaleal shunt
