Is a ventriculosubgaleal shunt safe for babies with posthemorrhagic hydrocephalus and intraventricular hemorrhage?

For premature babies with intraventricular hemorrhage (IVH) who develop posthemorrhagic hydrocephalus (PHH), doctors often need a temporary way to drain excess fluid until the baby is big enough for a permanent shunt. A ventriculosubgaleal shunt (VSGS) drains fluid into a pocket under the scalp. Systematic reviews suggest VSGS is a safe option with low complication rates.

What the research says

A 2025 systematic review and meta-analysis of 19 studies including 562 neonates found that VSGS has a pooled infection rate of only 9% and a revision rate of 4% ⁵⁹. Catheter obstruction occurred in 2% of cases, and catheter migration in 1% ⁵⁹. Overall mortality was 11%, but procedure-related mortality was just 1% ⁵⁹. These numbers suggest VSGS is relatively safe for this fragile population.

An older study from 1995 reported 15 premature infants who received VSGS with no complications, and 3 of those 15 did not need any further shunt treatment ¹⁰. This supports the idea that VSGS can be a temporary solution that sometimes resolves hydrocephalus without needing a permanent shunt.

Compared to other temporary methods like external ventricular drains (EVD), VSGS has similar infection rates. A 2022 study of antibiotic-impregnated EVD in low birth weight infants found a 7.7% infection rate ¹¹, which is close to the 9% rate for VSGS. However, VSGS avoids the need for repeated EVD placements and may be more convenient for longer-term drainage.

What to ask your doctor

• What are the infection and revision rates for VSGS at your hospital?
• How does VSGS compare to other temporary drainage options like ventricular access devices or EVD for my baby?
• What is the typical timeline for converting a VSGS to a permanent shunt if needed?
• Are there any specific risks for my baby given their gestational age and IVH grade?
• How will we monitor for complications like catheter obstruction or CSF leakage?