Rationale of ventriculosubgaleal shunt in minimizing complications after post haemorrhagic acute hydrocephalus

Background Hydrocephalus (HCP) due to subarachnoid haemorrhage (SAH) or intraventricular haemorrhage (IVH) is often temporary and could be resolved following the management of haemorrhage. Temporary approaches occasionally utilized in acute hydrocephalus treatment include extraventricular drainage (EVD) or ventriculosubgaleal shunt (VSGS). Every method has benefits and drawbacks. Objective To evaluate the effectiveness and safety of VSGS in temporarily diverting cerebrospinal fluid (CSF) to the subgaleal space in cases of acute hydrocephalus secondary to subarachnoid, intraventricular haemorrhage or cerebellar haemorrhage. Materials and methods This was a prospective study conducted on 30 patients with Hydrocephalus due to IVH, subarachnoid haemorrhage or cerebellar haemorrhage. The outcomes were assessed by requirement of ventriculpertoineal shunt (VPS), Modified Rankin Scale (mRS), number of procedures required till the resolution of the HCP or conversion from a temporizing device to a permanent shunt, the presence of complications and mortality rate. Results The outcomes among the cases are 80% with no complications, 16.7% have obstruction of the shunt and 3.3% have Pnemocephalus, 16.7% of the cases died while 83.3% survived. There was a significant relationship between the site of haemorrhage and no. of approaches needed till full resolution or conversion from a temporizing device to a permanent shunt) and complications. There was non-statistically significant association between site of haemorrhage and mortality and conscious level on admission or on follow-up. Conclusion Ventriculosubgaleal shunt is a safe and feasible approach for adult HCP cases, with the ability to demonstrate promising efficacy in managing acute hydrocephalus secondary to haemorrhage, with comparable outcomes to EVD and lower complication rates in certain aspects. Further prospective studies are warranted to validate these findings and establish standardized guidelines for optimal shunt selection in this patient population.