Comparison of the use of ventricular access devices and ventriculosubgaleal shunts in posthaemorrhagic hydrocephalus: systematic review and meta-analysis

INTRODUCTION: Ventricular access devices (VAD) and ventriculosubgaleal shunts (VSGS) are currently both used as temporising devices to affect CSF drainage in neonatal posthaemorrhagic hydrocephalus (PHH), without clear evidence of superiority of either procedure. In this systematic review and meta-analysis, we compared the VSGS and VAD regarding complication rates, ventriculoperitoneal shunt conversion and infection rates, and mortality and long-term disability. METHODS: The review was registered with the PROSPERO international prospective register of systematic reviews (registration number CRD42015019750) and was conducted in accordance with PRISMA guidelines. RESULTS AND CONCLUSIONS: The literature search of five databases identified 338 publications, of which 5 met the inclusion criteria. All were retrospective cohort studies (evidence class 3b and 4). A significantly lower proportion of patients with a VSGS required CSF tapping compared to patients with a VAD (log OR −4.43, 95 % CI −6.14 to −2.72). No other significant differences between the VAD and VSGS were identified in their rates of infection (log OR 0.03, 95 % CI −0.77 to 0.84), obstruction (log OR 1.25, 95 % CI −0.21 to 2.71), ventriculoperitoneal shunt dependence (log OR −0.06, 95 % CI −0.93 to 0.82), subsequent shunt infection (log OR 0.23, 95 % CI −0.61 to 1.06), mortality (log OR 0.37, 95 % CI −0.95 to 1.70) or long-term disability (p = 0.9). In all studies, there was a lack of standardised criteria, variations between surgeons in heterogeneous cohorts of limited sample size and a lack of neurodevelopmental follow-up. This affirms the importance of an ongoing multicentre, prospective pilot study comparing these two temporising procedures to enable a more robust comparison. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00381-015-2951-8) contains supplementary material, which is available to authorized users.