LETTER TO EDITOR
Year : 2019  |  Volume : 14  |  Issue : 2  |  Page : 105

Outcome of ventriculosubgaleal shunt in management of hydrocephalus

Jogender Kumar
Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication

20-Aug-2019

Correspondence Address:
Dr. Jogender Kumar
1044, Sector 15 B, Chandigarh 160015.
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jpn.JPN_139_18

How to cite this article: Kumar J. Outcome of ventriculosubgaleal shunt in management of hydrocephalus. J Pediatr Neurosci 2019;14:105

How to cite this URL: Kumar J. Outcome of ventriculosubgaleal shunt in management of hydrocephalus. J Pediatr Neurosci [serial online] 2019 [cited 2023 Jun 6];14:105. Available from: https://www.pediatricneurosciences.com/text.asp?2019/14/2/105/264738

Dear Editor,

We read with great interest the article by Kutty et al.^[1] in the recent issue of your journal. I would like to commend the authors for their endeavor to bring this data from developing countries, but at the same time have the following comments to offer, explanation to which will benefit the readership of the journal.

1. The authors compare only two variables as the outcome of interest in the form of mortality and conversion to ventriculoperitoneal shunt (VPS) and labeled them as “good” and “bad.” This classification seems to be too oversimplified. Neurodevelopmental outcome and arrest of the hydrocephalus of the preterm neonates undergoing shunt surgery are very crucial outcomes and should have been enlisted as one of the outcome measures.^[2]



2. Babies having ventriculosubgaleal (VSG) shunt may remain more stable and in better condition than those with VP shunt. In these conditions, if the neurodevelopmental outcome is acceptable and there is no further progression of hydrocephalus, then VP shunt may not be warranted. Hence, considering VP shunt conversion as an outcome may be fallacious.



3. The authors have not defined the criteria to be fulfilled for conversion to VPS. In the absence of predefined criteria, the comparison of time to VPS may be very heterogeneous and noncomparable.



4. It would have been reasonable to compare shunt revision/malfunction rates and other complications among the two groups.



5. The inclusion of patients in whom VSG was inserted in another hospital may introduce significant heterogeneity as the technique, expertise, and postoperative care differ across various institutions.



6. Currently, there is insufficient evidence to recommend specific parameters such as cerebrospinal fluid sugar/protein/cell count to direct the timing of shunt placement in premature infants with hydrocephalus. So, what was the rationale for considering protein >500 mg/dL as sole criteria for VPS?^[3]

References

1.	Kutty RK, Sreemathyamma SB, Korde P, Prabhakar RB, Peethambaran A, Libu GK. Outcome of ventriculosubgaleal shunt in the management of infectious and non-infectious hydrocephalus in pre-term infants. J Pediatr Neurosci 2018;13:322-8.   [PUBMED]  [Full text]
2.	Badhiwala JH, Hong CJ, Nassiri F, Hong BY, Riva-Cambrin J, Kulkarni AV. Treatment of posthemorrhagic ventricular dilation in preterm infants: a systematic review and meta-analysis of outcomes and complications. J Neurosurg Pediatr 2015;16:545-55.
3.	Mazzola CA, Choudhri AF, Auguste KI, Limbrick DD, Rogido M, Mitchell L, et al. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants. J Neurosurg Pediatr 2014;14:8-23.