Short Efficacy Evaluation of External Ventricular Drains Versus Ventriculosubgaleal Shunt in the Management of Neonatal Posthemorrhagic Hydrocephalus: A Retrospective Single-Center Cohort Study.
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
01 09 2023
01 09 2023
Historique:
received:
12
08
2022
accepted:
23
01
2023
medline:
16
8
2023
pubmed:
23
3
2023
entrez:
22
3
2023
Statut:
ppublish
Résumé
Different temporizing neurosurgical procedures are available for the management of posthemorrhagic hydrocephalus in preterm newborns. To evaluate the short efficacy of the external ventricular drains (EVDs) and the ventriculosubgaleal (VSG) shunt. This is a Strengthening the Reporting of Observational Studies in Epidemiology-conformed retrospective cohort study. The inclusion criteria were (1) gestational age <37 weeks, (2) birth weight <1500 g, (3) posthemorrhagic hydrocephalus because of intraventricular hemorrhage grade II/III, and (4) EVD or VSG shunt procedure before ventriculoperitoneal (VP)-definite shunt. Twenty-four newborns were collected from 2006 to 2022. The end points considered were infectious events, proteinorrachia, reintervention rate, and time to conversion to definite VP shunt. Overall, 12/24 newborns underwent EVD, and the remnant had a VSG shunt. The results showed a statistically significant difference ( P = .02) concerning cerebrospinal fluid infections between the EVD group (50%) and VSG shunt 1 (8.33%). The reintervention rate of EVD was significantly higher (66.67%) compared with that of the VSG shunt group (8.33%). A statistically significant difference was stated between the 2 groups (t[13] = -8.250; P < .001) (mean difference ± standard error; 10.5 ± 1.273) in the mean number of days elapsed from the achievement of the ideal weight (2000 g) to the definitive VP drainage. The increased infectious risk and the higher reintervention rate in EVD were confirmed in this study. In addition, a significant delay in the time to -conversion from EVD to VP shunt was demonstrated. Despite these optimal results, the VSG shunt remains a low practiced intervention, probably because of the limited operator experience.
Sections du résumé
BACKGROUND
Different temporizing neurosurgical procedures are available for the management of posthemorrhagic hydrocephalus in preterm newborns.
OBJECTIVE
To evaluate the short efficacy of the external ventricular drains (EVDs) and the ventriculosubgaleal (VSG) shunt.
METHODS
This is a Strengthening the Reporting of Observational Studies in Epidemiology-conformed retrospective cohort study. The inclusion criteria were (1) gestational age <37 weeks, (2) birth weight <1500 g, (3) posthemorrhagic hydrocephalus because of intraventricular hemorrhage grade II/III, and (4) EVD or VSG shunt procedure before ventriculoperitoneal (VP)-definite shunt. Twenty-four newborns were collected from 2006 to 2022. The end points considered were infectious events, proteinorrachia, reintervention rate, and time to conversion to definite VP shunt.
RESULTS
Overall, 12/24 newborns underwent EVD, and the remnant had a VSG shunt. The results showed a statistically significant difference ( P = .02) concerning cerebrospinal fluid infections between the EVD group (50%) and VSG shunt 1 (8.33%). The reintervention rate of EVD was significantly higher (66.67%) compared with that of the VSG shunt group (8.33%). A statistically significant difference was stated between the 2 groups (t[13] = -8.250; P < .001) (mean difference ± standard error; 10.5 ± 1.273) in the mean number of days elapsed from the achievement of the ideal weight (2000 g) to the definitive VP drainage.
CONCLUSION
The increased infectious risk and the higher reintervention rate in EVD were confirmed in this study. In addition, a significant delay in the time to -conversion from EVD to VP shunt was demonstrated. Despite these optimal results, the VSG shunt remains a low practiced intervention, probably because of the limited operator experience.
Identifiants
pubmed: 36946584
doi: 10.1227/neu.0000000000002459
pii: 00006123-202309000-00016
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
622-627Informations de copyright
Copyright © Congress of Neurological Surgeons 2023. All rights reserved.
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