Systematic review and meta-analysis finds ventriculosubgaleal shunt safe in premature neonates with posthemorrhagic hydrocephalus

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Neurosurgical review Published May 2, 2026 Medically reviewed May 7, 2026 Study authors: Gomes Cabral Junior Stefeson, Sousa Marcelo Porto, Ribeiro Filipe Virgilio, Pereira Maria Antonia Ol… PubMed ↗ DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Consider VSGS as a safe option for posthemorrhagic hydrocephalus in premature neonates, but evidence is from observational studies.

This systematic review and meta-analysis included 562 premature neonates with posthemorrhagic hydrocephalus due to intraventricular hemorrhage. The intervention assessed was ventriculosubgaleal shunt (VSGS). The primary outcomes included VSGS-related infection, revision, catheter migration, obstruction, CSF leakage, permanent VPS placement, overall mortality, and procedure-related mortality.

Pooled results showed a VSGS-related infection rate of 9% (95%CI: 5% to 12%), revision rate of 4% (95%CI: 0% to 8%), catheter obstruction rate of 2% (95%CI: 0% to 5%), catheter migration rate of 1% (95%CI: 0% to 5%), CSF leakage rate of 6% (95%CI: 3% to 9%), permanent VPS placement rate of 75% (95%CI: 67% to 82%), overall mortality of 10% (95%CI: 4% to 16%), and procedure-related mortality of 1% (95%CI: 0% to 2%).

The authors did not explicitly report limitations, but as a meta-analysis of observational studies, confounding and selection bias are inherent. The practice relevance is that VSGS is identified as a safe and effective option for treating hydrocephalus caused by IVH in premature neonates. However, clinicians should interpret these findings cautiously given the observational nature of the included studies and the lack of a comparator group.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

PMID42067675

View Original Abstract ↓

Intraventricular hemorrhage (IVH) is a severe complication in premature neonates, occurring in 25%-30% of cases and often leading to posthemorrhagic hydrocephalus (PHH). When blood clots in the cerebrospinal fluid (CSF), preventing permanent shunt placement, temporary interventions are considered. Ventriculosubgaleal shunt (VSGS) utilizes the subgaleal space to absorb and drain excess CSF, reducing infection risk and allowing hydrocephalus control until the neonate reaches an appropriate weight and CSF clarity. This systematic review and meta-analysis evaluate the safety and efficacy of VSGS in treating neonatal PHH. A systematic review was conducted using Medline, Embase, and Web of Science following Cochrane and PRISMA guidelines. Eligible studies included those with ≥ 4 neonates. The primary outcomes analyzed were VSGS-related infection, VSGS revision, VSGS catheter migration, catheter obstruction, VSGS-related CSF leakage, permanent ventriculoperitoneal shunt (VPS) placement, overall mortality, and procedure-related mortality. A total of nineteen studies, encompassing 562 neonates, were included in our analysis. The pooled VSGS-related infection rate was 9% (95%CI: 5% to 12%). The need for VSGS revision was observed in 4% of cases (95%CI: 0% to 8%). The catheter obstruction rate was 2% (95% CI: 0% to 5%), while VSGS catheter migration occurred in 1% of cases (95%CI: 0% to 5%). VSGS-related CSF leakage was reported in 6% of neonates (95%CI: 3% to 9%). Permanent VPS placement was required in 75% of patients (95%CI: 67% to 82%). The overall mortality rate was 10% (95%CI: 4% to 16%), and the procedure-related mortality rate was 1% (95%CI: 0% to 2%). This systematic review and meta-analysis identified VSGS as a safe and effective option for treating hydrocephalus caused by IVH in premature neonates.