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SUBGALEAL SHUNTING FOR POSTHEMORRHAGIC HYDROCEPHALUS - TECHNICAL NOTE
Subgaleal shunting (SGS) for posthemorrhgic hydrocephalus (PHH), is considered as an option to control the intracranial hypertension of those preterms affected. This paper suggests a standard technique of valveless shunt.
Materiais e Métodos/Casuística
A right precoronal 2 cm “S” shape incision is made and subgaleal (SG) space is entered. A blunt dissection creates a pocket, as big as one can do, within the SG space giving enough room to house de CSF drained from the ventricle. A burr hole is made at the Koch’s point followed by standard puncture of the frontal horn. The ideal catheter is 10 – 14 cm, one piece, with inline reservoir and distal end catheter with no second piece or ligatures, and no valve as well; thus, the hemorrhagic CSF can flow directly to the SG pocket as needed. The better closure should be done in two layer sutures and we prefer non-absorbable stitches at the skin, decreasing dehiscence of the wound stretched by the CSF pocket.
The “S” shape incision gives more elasticity to accommodate the reservoir beneath the thin skin as well allows the more generous dissection of the SG space; the aesthetics is improved too. We always implant valveless devices to ensure the ongoing drainage of the CSF and lessering the obstructions. A ventricular catheter with inline reservoir and distal end is preferable rather than a free catheter since the first can be punctured anytime when the outflow is getting obstructed; and better than Omaya reservoir, in our opinion, since the last is bigger in a higher profile and do not collect CSF at the SG space.
Discussão e Conclusões
SGS is a good alternative method to treat PHH, and this technique variation proposed herein can maintain the CSF shunt for a longer time span thus lowering complications.
1. Welllons J et al: A multicenter retrospective comparison of conversion from temporary to permanent cerebrospinal fluid diversion in very low birth weight infants with posthemorrhagic hydrocephalus. J Neurosurgery Pediatrics 4 : 50-55, 2009
2. Robinson S: Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts. J Neurosurg Pediatrics 9 : 242-258, 2012
3. Limbrick Jr, D. et al : Neurosurgical treatment of progressive posthemorrhagic ventricular dilatation in preterm infants: a 10-year single-institution study. J Neurosurgery Pediatrics 6 : 224-230, 2010
subgaleal shuntig, valveless, posthemorrhagic hydrocephalus
UNIVERSIDADE ESTADUAL DE LONDRINA - Parana - Brasil
ALEXANDRE CASAGRANDE CANHEU, MARCIO FRANCISCO LEHMANN, SERGIO MURILO GEORGETO, FELIPE INACIO FERREIRA DA SILVA, BRUNO LOOF, FRANCISO SPESSATO PESENTE