Comparative Efficacy of Ventriculosubgaleal Shunt Versus Ventricular Reservoir in Achieving Shunt Independence for Infants With Posthemorrhagic Hydrocephalus by 6 Months

BACKGROUND AND OBJECTIVES: Low-birth weight, premature infants often have severe intraventricular hemorrhage (IVH), which can result in posthemorrhagic hydrocephalus (PHH), sometimes requiring cerebrospinal fluid diversion. Initial temporizing management of PHH includes placement of a ventriculosubgaleal shunt (VSGS) or ventricular access device (VAD). Studies have found similar permanent shunt conversion rates between VSGS and VAD but were limited by sample scope and size. The rate of conversion to permanent shunt within 6 months post-IVH in premature infants, comparing the efficacy of VSGS and VAD, remains underexplored. METHODS: This retrospective study used International Classification of Diseases-10 codes in the PearlDiver Mariner database to analyze the medical records of premature infants diagnosed with grade 3 or 4 IVH who underwent VAD or VSGS treatment. A 2:1 matching process was used to control demographics, IVH severity, degree of prematurity, and associated respiratory or gastrointestinal conditions. We assessed the rates and odds of conversion to permanent shunts within 6 months, using Kaplan-Meier plots for shunt-free probability and log-rank tests for distribution comparisons. RESULTS: Our matched analysis included 222 infants (VAD, n = 145, VSGS, n = 77) and demonstrated no difference in the proportion of gender, respiratory conditions, necrotizing enterocolitis, extreme prematurity, and Grade III or IV IVH. The odds of requiring a permanent shunt were significantly lower in the VSGS group compared with the VAD group within 6 months (odds ratio: 0.22, 95% CI [0.12, 0.41], P <.001). From day 60 onward, Kaplan-Meier plots indicated a notable divergence in shunt-free probability within 6 months (Log-Rank P <.001). CONCLUSION: This study highlights a significant reduction in the need for permanent shunt placement within 6 months for post-IVH in premature infants who underwent VSGS vs VAD, suggesting that VSGS may be a more favorable temporizing procedure for managing PHH in this vulnerable population.