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G108(P) A novel neurosurgical protocol for management of preterm infants with intraventricular haemorrhage using CSF shunting to the subgaleal space
  1. M Kang1,
  2. G James2
  1. 1Medicine, Barts and the London School of Medicine and Dentistry, London, UK
  2. 2Neurosurgery, Great Ormond Street Hospital, London, UK

Abstract

Aims IVH and posthaemorrhagic hydrocephalus (PHH) are common and major complications of prematurity. Management usually requires surgical intervention to temporarily or permanently drain CSF. In 2012 we introduced a new protocol for management of preterm IVH using ventriculosubgaleal shunt (VSGS) – a tube that drains CSF from the ventricle of the brain to a subgaleal scalp pocket – as the preferred temporising device. The protocol involves using VSGS for babies with 1) ventricular indices (VI) >97th centile +4 mm, or 2) ventriculomegaly with clinical evidence of raised intracranial pressure. This study examines outcomes of the first cohort of patients managed at a tertiary paediatric neurosurgical centre using this protocol.

Methods A retrospective case review of consecutive patients treated on protocol within the first 2 years following its introduction (2012–2014). Electronic patient records and databases were interrogated using a study proforma.

Results 20 patients were identified during the study period. 1 patient was an out-of-area referral who was repatriated and no follow up data was available so was excluded from analysis. Of the 19 subjects, mean follow up duration was 516 d (range 137- 1056). 18 (95%) had Papile grade 3 or 4 IVH at the time of referral, 1 had Papile grade 2. At the time of VSGS insertion, mean gestational age was 31+1 weeks (range 26+4–36 + 4) and mean weight was 1171g (range 758–1600g). VI was reduced a mean 7.6 mm following insertion. There were 5 operative complications; 2 shunt infections, 2 shunt failures requiring revision, and 1 decompression haemorrhage (managed conservatively). 18 required permanent CSF shunting. This occurred a mean of 79 days (range 24–349) after the VSGS insertion. There was no mortality.

Conclusion This protocol is a safe and efficacious method of managing preterm IVH. When compared to other series, our complication rate was favourable, particularly in view of the age and weight profile of our population. The rate of conversion to permanent CSF shunt was high and may reflect the generally poor Papile grade of our referred patients.

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