Comparing ventricular access devices and ventriculosubgaleal shunts for posthemorrhagic ventricular dilatation: systematic review and meta-analysis

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Abstract
Background The complications of severe intraventricular hemorrhage (IVH), such as posthemorrhagic ventricular dilatation (PHVD) or posthemorrhagic hydrocephalus (PHH), affect 25–80% of infants with this condition. These conditions increase morbidity, mortality, and long-term neurodevelopmental outcomes. Ventricular access devices (VADs) and ventriculosubgaleal shunts (VSGSs) are temporary cerebrospinal fluid diversion methods for PHVD management. The aim of this study was to compare the effectiveness of VADs and VSGSs in reducing PHVD-related complications. Methods A comprehensive search through the Ovid interface was conducted, including Embase (1974 to October 9, 2023), the Cochrane Central Register of Controlled Trials, CENTRAL (September 2023), and Ovid MEDLINE (1946 to October 9, 2023). All randomized controlled trials (RCTs) and nonrandomized studies comparing VADs and VSGSs, and peer-reviewed published original research, were selected. Meta-analyses were performed using a fixed-effects model and the Mantel‒Haenszel method. Results Six observational studies (one prospective cohort and five retrospective cohorts) with a total of 497 infants were included, and no RCTs were found. For the primary outcome (permanent shunt insertion), a meta-analysis of six observational studies revealed no difference in intervention benefit (RR 1.02, 95% CI 0.91 to 1.14). VADs had little to no effect on mortality (two studies: RR 0.56, 95% CI 0.25 to 1.26), CSF infection (five studies: RR 1.24, 95% CI 0.72 to 2.11) or CSF leakage (two studies: RR 0.64, 95% CI 0.14 to 2.86). Conclusions The evidence regarding VAD or VSGS use for infants with PHVD is limited to observational studies. Thus, the effects of VADs on PHVD-related complications are very uncertain. High-quality RCTs are needed to determine the optimal temporizing device for high-risk preterm infants with PHVD.

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