A multicenter retrospective comparison of conversion from temporary to permanent cerebrospinal fluid diversion in very low birth weight infants with posthemorrhagic hydrocephalus

Clinical article

John C. Wellons IIISection of Pediatric Neurosurgery, Children's Hospital of Alabama, Division of Neurosurgery, University of Alabama at Birmingham, Alabama;

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Chevis N. ShannonSection of Pediatric Neurosurgery, Children's Hospital of Alabama, Division of Neurosurgery, University of Alabama at Birmingham, Alabama;

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Abhaya V. KulkarniDivision of Neurosurgery, Hospital for Sick Children, Toronto, Canada;

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Tamara D. SimonDepartment of Pediatrics, Division of Inpatient Medicine, University of Utah, Salt Lake City;

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Jay Riva-CambrinDivision of Pediatric Neurosurgery, Primary Children's Hospital, Department of Neurosurgery, University of Utah, Salt Lake City, Utah; and

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William E. WhiteheadDivision of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas

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W. Jerry OakesSection of Pediatric Neurosurgery, Children's Hospital of Alabama, Division of Neurosurgery, University of Alabama at Birmingham, Alabama;

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James M. DrakeDivision of Neurosurgery, Hospital for Sick Children, Toronto, Canada;

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Thomas G. LuerssenDivision of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas

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Marion L. WalkerDivision of Pediatric Neurosurgery, Primary Children's Hospital, Department of Neurosurgery, University of Utah, Salt Lake City, Utah; and

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John R. W. KestleDivision of Pediatric Neurosurgery, Primary Children's Hospital, Department of Neurosurgery, University of Utah, Salt Lake City, Utah; and

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for the Hydrocephalus Clinical Research Network
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Object

The purpose of this study was to define the incidence of permanent shunt placement and infection in patients who have undergone the 2 most commonly performed temporizing procedures for posthemorrhagic hydrocephalus (PHH) of prematurity: ventriculosubgaleal (VSG) shunt placement and ventricular reservoir placement for intermittent tapping.

Methods

The 4 centers of the Hydrocephalus Clinical Research Network participated in a retrospective chart review of infants with PHH who underwent treatment at each institution between 2001 and 2006. Patients were included if they had received a diagnosis of Grade 3 or 4 intraventricular hemorrhage, weighed < 1500 g at birth, and had received surgical intervention. The authors determined the incidence of conversion from a temporizing device to a permanent shunt, the incidence of CSF infection during temporization, and the 6-month CSF infection rate after permanent shunt placement.

Results

Thirty-one (86%) of 36 patients who received VSG shunts and 61 (69%) of 88 patients who received ventricular reservoirs received permanent CSF diversion with a shunt (p = 0.05). Five patients (14%) in the VSG shunt group had CSF infections during temporization, compared with 11 patients (13%) in the ventricular reservoir group (p = 0.83). The 6-month incidence of permanent shunt infection in the VSG shunt group was 16% (5 of 31), compared with 12% (7 of 61) in the reservoir placement group (p = 0.65). For the first 6 months after permanent shunt placement, infants with no preceding temporizing procedure had an infection rate of 5% (1 of 20 infants) and those who had undergone a temporizing procedure had an infection rate of 13% (12 of 92; p = 0.45).

Conclusions

The use of intermittent tapping of ventricular reservoirs in this population appears to lead to a lower incidence of permanent shunt placement than the use of VSG shunts. The incidence of infection during temporization and for the initial 6 months after conversion appears comparable for both groups. The apparent difference identified in this pilot study requires confirmation in a more rigorous study.

Abbreviations used in this paper:

HCRN = Hydrocephalus Clinical Research Network; IVH = intraventricular hemorrhage; PHH = posthemorrhagic hydrocephalus; VP = ventriculoperitoneal; VSG = ventriculosubgaleal.
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