Bleil Cristina, Vitulli Francesca, Mirza Asfand Baig, Boardman Timothy Martyn, Al Banna Qusai, AlFaiadh Wisam, Zebian Bassel
Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II" University of Naples, Via Sergio Pansini n.5, 80131, Naples, Italy.
Childs Nerv Syst. 2023 Nov;39(11):3263-3271. doi: 10.1007/s00381-023-06125-6. Epub 2023 Aug 16.
Germinal matrix / intraventricular haemorrhage (GMIVH) remains a significant complication of prematurity. The more severe grades are associated with parenchymal haemorrhagic infarction (PHI) and hydrocephalus. A temporising procedure is usually the first line in management of neonatal post-haemorrhagic hydrocephalus (nPHH) as the risk of failure of a permanent cerebrospinal fluid (CSF) diversion is higher in the early stage. Our choice of temporising procedure is a ventriculosubgaleal shunt (VSGS). In this technical note, we describe a modification in technique whereby the pocket of the VSGS is fashioned away from the surgical wound. This resulted in lower CSF leak and subsequent infection rates in our centre.
We conducted a retrospective analysis of all patients who underwent insertion of a VSGS between September 2014 and February 2023.
Twenty children were included in our study with a mean gestational age of 31 weeks + 4 days. Post-operatively, 10% of patients did not need a tap, and 10%, 20%, 15%, 25% and 20% respectively had 1, 2, 3, 4 and 5 taps. Two patients experienced CSF leak from their wounds. In both these patients, the pocket was deemed too close to the wound. None of the patients without suspected pre-existing CNS infection at the time of insertion of VSGS had a subsequent VSGS-related infection. VSGS conversion to permanent ventriculoperitoneal shunts (VPS) was required in 15 (75%) of the patients with an average interval duration of 72 days. On reviewing the literature, the infection rate following VSGS is quoted up to 13.5%. In our own centre, 13 patients had undergone VSGS insertion between 2005 and 2013 with a 30.8% infection rate which seemed related to increased leak rates.
Our modified surgical approach seems to be effective in reducing the risk of infection, which we postulate is a direct result of reduction in the risk of leak from the surgical wound.
生发基质/脑室内出血（GMIVH）仍然是早产的一个重要并发症。较严重的级别与脑实质出血性梗死（PHI）和脑积水有关。作为一种临时措施通常是新生儿出血后脑积水（nPHH）治疗的一线方法，因为在早期进行永久性脑脊液（CSF）分流失败的风险更高。我们选择的临时措施是脑室-帽状腱膜下分流术（VSGS）。在本技术说明中，我们描述了一种技术改进，即VSGS的囊袋远离手术切口制作。这使得我们中心的脑脊液漏和随后的感染率降低。
我们对2014年9月至2023年2月期间所有接受VSGS植入手术的患者进行了回顾性分析。
我们的研究纳入了20名儿童，平均胎龄为31周+4天。术后，10%的患者不需要穿刺引流，分别有10%、20%、15%、25%和20%的患者进行了1次、2次、3次、4次和5次穿刺引流。两名患者伤口出现脑脊液漏。在这两名患者中，囊袋被认为离伤口太近。在植入VSGS时没有疑似既往中枢神经系统感染的患者中，没有一人随后发生与VSGS相关的感染。15名（75%）患者需要将VSGS转换为永久性脑室-腹腔分流术（VPS），平均间隔时间为72天。查阅文献可知，VSGS后的感染率高达13.5%。在我们自己的中心，2005年至2013年期间有13名患者接受了VSGS植入，感染率为30.8%，这似乎与渗漏率增加有关。
我们改进的手术方法似乎有效地降低了感染风险，我们推测这是手术伤口渗漏风险降低的直接结果。
