Introduction: Posthemorrhagic hydrocephalus comprises the most common complication in those premature
neonates whose suffered germinative matrix hemorrhage, and its treatment is still
matter of controversies. These infants usually weight less than 1,500 g and a temporary
CSF diversion device is needed. This paper depicts the initial 17 cases of ventriculosubgaleal
shunting (VSGS) in prematures who suffered grades III and IV periventricular hemorrhage
and hipertensive hydrocephalus.
Methods: Our technique consists of subgaeal valveless shunt. We analyzed a series of 17 preterm
infants who underwent VSGS for posthemorrhagic hydrocephalus between July 2015 and
November 2017. The median gestation age was 28 weeks (range 23–32). The median weight
was 890 grams (range 625–1,615). The mean span of time harboring de VSGS was 59,3
days (range 39–78).
Results: The cases were studied for: 1) revision of the system: 4 subjects (23,5%) had 2 system
revisions each due to obstruction; 2) shunt related complications: 5 infants (29%)
had positive CSF culture and the VSG converted to EVD and further VP shunt (2 of these
showed previous CSF fistula through the wound); 4) convertion to VP shunt: 9 children
(52,3%) showed persistent hydrocephalus at further investigation, and underwent to
VP shunt after stable clinical condition and weight higher than 2,000 g. One death
occurred in a very low birth weight subject who developed severe thrombocytopenia
and pulmonary hemorrhage.
Conclusions: VSGS is a good alternative method to treat posthemorrhagic hydrocephalus, specially
in preterm infant whose need a temporary shunt device. The low rate of severe complications
and encouraging results about persistent hydrocephalus should guide further investigation
and larger cases series.
