Single-Stage Treatment of Spina Bifida with Hydrocephalus Based on a Prediction Rule Derived from Preoperative Cranial Ultrasound

Abstract

Aims: It was the aim of this study to report a prospective study of 110 spina bifida patients with hydrocephalus treated by simultaneous ventriculoperitoneal (VP) shunt and repair of the meningomyelocele. Methods: Between January 2005 and February 2008, 264 patients with spina bifida were admitted to the author’s department. Those patients in whom the preoperative cranial ultrasonography measurement of the bifrontal diameter was >26 mm, the bicaudate diameter >20 mm and the diameter of the body of the lateral ventricle >26 mm were predicted to develop postoperative hydrocephalus (n = 245). Of these, 110 patients underwent simultaneous (group 1) VP shunt with repair of the meningomyelocele, while 135 (group 2) underwent sequential surgery due to the preference of the attending consultant. Results: Twenty-two of the 110 patients in group 1 developed complications (wound problems, cerebrospinal fluid leak, shunt malfunction, death) compared with 38 of 135 patients in group 2. The remaining patients had an uneventful postoperative and follow-up course. Conclusions: Simultaneous VP shunt with surgery for hydrocephalus was feasible in our setup. The rate of complications was not higher than in staged surgery. Single-stage repair of spina bifida with hydrocephalus offers considerable advantage in the form of a reduction in hospital burden, costs and patient morbidity.

Myelomeningocele-associated hydrocephalus: nationwide analysis and systematic review

“…Many of the identified studies investigating timing of treatment are from countries other than America and cite a socioeconomically challenged population, in which ST is preferred due to its lower economic burden. 49,60 As one may expect, the wealthier patients in the NIS comprised a smaller portion of MMC patients and had a lower incidence of associated hydrocephalus. Unexpectedly, when treated, wealthier NIS-MMC hydrocephalic patients were more likely to receive ST treatment.…”

Timing of shunt placement relative to shunt infections in cases of hydrocephalus associated with myelomeningocele

“…These authors also emphasized that shunt insertion might not be needed in patients with mild and non-progressive hydrocephalus, and that unnecessary shunting could be avoided. In contrast, others have published in favor of simultaneous MMC repair and shunting in the same session (12,19,23,25). They assert that this approach facilitates more rapid recovery of the MMC wound, avoids further brain damage that can occur with delayed shunting, and carries lower risk of cerebrospinal fluid (CSF) leakage.…”