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Objective <p>The pediatric neurosurgical literature supports the placement of a ventricular access device (VAD) in the premature infant with posthemorrhagic ventricular dilatation as a temporizing measure prior to definitive diversionary shunting. However, there is an absence of data identifying the clinical utility and significance of VADs left in situ at the time of permanent shunt placement. The potential risks of leaving an initial VAD at the time of definitive contralateral cerebral spinal fluid (CSF) diversion and the benefits of a concomitant VAD in these patients with regard to potential life-saving or temporizing aspirations are not well documented. </p> Methods <p>Retrospective cohort review of premature infants (&lt; 37&#xa0;weeks gestational age) treated for PHH at a tertiary pediatric neurosurgery center from January 2005 to December 2021. Patients were grouped by whether a previously placed VAD was retained during permanent shunt insertion. Outcomes measured: number and outcome of VAD taps, shunt revisions, shunt infections. Statistical comparison between the two groups; <i>p</i> &lt; 0.05 considered significant.</p> Results <p>Seventy-two premature patients (gestational age &lt; 37&#xa0;weeks) were identified. This cohort included 40 (55.55%) patients with both a VAD and shunt and 32 (44.44%) patients with a shunt only (12 with VAD removed at shunt insertion; 20 with no VAD insertion). Of the 40 patients with a shunt and VAD in situ, 17/40 (42.5%) had their VADs tapped at the time of shunt failure, resulting in 29 total VAD taps. There were 23 emergent VAD taps, of which 17/23 (73.91%) were successful. Leaving the VAD in situ did not result in increased rates of total shunt infections or revisions (<i>p</i> = 0.215; <i>p</i> = 0.129).</p> Conclusions <p>Based on this analysis, VADs placed for initial management of post-hemorrhagic IVH may serve an important role in children with subsequent proximal shunt malfunctions, potentially lifesaving. A high percentage of shunted patients with VADs benefited without increased risk of shunt revisions or infections. The decision for a VAD to remain in situ at the time of permanent shunt placement in these patients should be strongly considered.</p>

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The significance and utility of ventricular access devices in children with proximal CSF shunt malfunction

  • 期刊论文

  • 发表日期：

    2026年1月20日

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  • Kerri Thorn,
  • Brannan E. O’Neill,
  • Julie Wilson,
  • Katherine Hofmann,
  • Abdullah Feroze,
  • Daniel A. Donoho,
  • Chima O. Oluigbo,
  • Hasan R. Syed,
  • Robert F. Keating,
  • John S. Myseros

摘要

Objective

The pediatric neurosurgical literature supports the placement of a ventricular access device (VAD) in the premature infant with posthemorrhagic ventricular dilatation as a temporizing measure prior to definitive diversionary shunting. However, there is an absence of data identifying the clinical utility and significance of VADs left in situ at the time of permanent shunt placement. The potential risks of leaving an initial VAD at the time of definitive contralateral cerebral spinal fluid (CSF) diversion and the benefits of a concomitant VAD in these patients with regard to potential life-saving or temporizing aspirations are not well documented.

Methods

Retrospective cohort review of premature infants (< 37 weeks gestational age) treated for PHH at a tertiary pediatric neurosurgery center from January 2005 to December 2021. Patients were grouped by whether a previously placed VAD was retained during permanent shunt insertion. Outcomes measured: number and outcome of VAD taps, shunt revisions, shunt infections. Statistical comparison between the two groups; p < 0.05 considered significant.

Results

Seventy-two premature patients (gestational age < 37 weeks) were identified. This cohort included 40 (55.55%) patients with both a VAD and shunt and 32 (44.44%) patients with a shunt only (12 with VAD removed at shunt insertion; 20 with no VAD insertion). Of the 40 patients with a shunt and VAD in situ, 17/40 (42.5%) had their VADs tapped at the time of shunt failure, resulting in 29 total VAD taps. There were 23 emergent VAD taps, of which 17/23 (73.91%) were successful. Leaving the VAD in situ did not result in increased rates of total shunt infections or revisions (p = 0.215; p = 0.129).

Conclusions

Based on this analysis, VADs placed for initial management of post-hemorrhagic IVH may serve an important role in children with subsequent proximal shunt malfunctions, potentially lifesaving. A high percentage of shunted patients with VADs benefited without increased risk of shunt revisions or infections. The decision for a VAD to remain in situ at the time of permanent shunt placement in these patients should be strongly considered.