253. Ventriculo-Subgaleal Shunt Technique Modification To Avoid Subgaleal Pocket Collapse

Authors: Joaquin Hidalgo, MD; Edward Ahn, MD (Baltimore, MD)

Introduction:

Ventriculo-subgaleal shunt (VSGS) placement is a well stablished surgical technique in the treatment of hydrocephalus in neonates. Despite successful implantation, VSGS has a rate of failure as high as 30%. A common reason for failure of this technique is the collapse and scarring of the subgaleal pocket. We report a practical and simple technique modification to avoid scarring of the subgaleal pocket by placing a sheet as an adhesion barrier under the galeal plane. Our single center case series and experience is presented, technical pitfalls and benefits are discussed and illustrated

Methods:

A retrospective review of patients who were diagnosed with IVH and PHH at the Johns Hopkins Children’s Center was conducted. The medical records of the patients were reviewed for information on demographics, birth history, type of VSGS placement technique used, clinical course and complications. Rates of VSGS malfunction and complications with or without placement of the subgaleal sheet were calculated.

Results:

87 patients underwent VSGS placement due post hemorrhagic hydrocephalus in the setting of prematurity. In 57 of the patients a sterile sheet was implanted in the subgaleal pocket to prevent scalp scarring, in 30 patients a subgaleal sheet was not placed. The rate of VSGS revision was 3.5% (N = 2/57) in the group of patients where the sheet was implanted and 20% (6/30) in the group of patients were the conventional technique was used (P value= 0.0183). Complications consisted of: hardware infection (N= 7), Cranial hollowing with formation of leptomeningeal cyst (N=3) and hardware skin erosion (N=1).

Conclusion:

We present a practical surgical technique modification to reduce the rate of collapse of the subgaleal pocket and VSGS malfunction. This simple technique modification can diminish the rates of VSGS malfunction in a safely manner, its potential complications should be actively avoided and considered when used.