The prediction of postoperative hydrocephalus in patients with spina bifida

Wakhlu, Ashish; Ansari, Nisar Ahmad

doi:10.1007/s00381-003-0849-3

Cited by 21 publications

(9 citation statements)

References 2 publications

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“…By using a stringent shunt placement policy, recent studies by Chakraborty and co-workers[10] as well as Dirks et al .,[3] have demonstrated that the shunt insertion rate in patients with myelomeningocele is lower than that reported in the literature. [1–925]…”

Section: Discussionmentioning

confidence: 99%

“…However, the rate of shunt placement is reported in literature to be as high as over 85%. [1–9] This means that a large number of children with MMC who have already been suffering from severe disabilities due to spinal MMC, are exposed to the additional burden of serious shunt-related complications, including death. Thus, there exists a rationale to avoid shunt insertion in this population whenever possible.…”

Section: Introductionmentioning

confidence: 99%

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Reducing CSF shunt placement in patients with spinal myelomeningocele

Sankhla

Khan

2009

J Pediatr Neurosci

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Object:The incidence of hydrocephalus requiring shunts in children with myelomeningocele (MMC) is reported to be very high. Shunt-related complications are a significant cause of morbidity and mortality in this population. In order to minimize shunt placements, we used very rigid clinical selection criteria and followed them in all patients who had myelomeningocele and enlarged ventricles. The follow-up outcome of this retrospective study is reported.Methods:From 2000 to 2007, 23 patients with myelomeningocele and variable degree of hydrocephalus were treated at our institute with primary surgical closure of their myelomeningoceles without a CSF diversion procedure. Patients with severe hydrocephalus who required immediate shunt insertion, and those with no significant associated hydrocephalus were not included in this study. Data regarding the surgical results and complications, postoperative management, and the outcome at follow-up were obtained from their hospital records.Results:Initially increased size of the ventricular system was found to have decreased or stabilized in 17 (81%) patients postoperatively. However, ventriculomegaly continued to progress further in 4 (19%) out of 21 patients. Of 11 patients who presented with enlarged head, eight (73%) patients showed reduction or stabilization in their head circumference. Three (27%) children continued to have progressive head enlargement in the postoperative period and required shunt placement. Signs of raised intracranial pressure observed in six patients on admission, improved in two (33%) and persisted or worsened in four (67%) patients who eventually improved after the insertion of a shunt. Eight (35%) patients experienced wound-related complications following closure of the MMC, including CSF leak in four, wound infection in three, wound breakdown in three, and pseudomeningocele in two patients. Shunt placement was required in the postoperative period in 13 (56.5%) patients to treat raised intracranial pressure in 11 and CSF leak from the wound in two patients.Conclusions:Our experience suggests that the placement of shunts can be reduced by adopting a policy with strict clinical and radiographic criteria. Shunt insertion should be reserved for only those patients who have severe hydrocephalus with clinical features of elevated intracranial pressure. Mild to moderate ventricular dilatation, persistent ventriculomagaly, and some increase in ventricular size after myelomeningocele repair can be treated successfully without a shunt.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reducing CSF shunt placement in patients with spinal myelomeningocele

Sankhla

Khan

2009

J Pediatr Neurosci

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“…In our study, the first requirement for simultaneous treatment was to be able to identify which patients of spina bifida would develop postoperative hydrocephalus with a statistical degree of certainty, using previously published criteria [9] for predicting the development of postoperative hydrocephalus in children with spina bifida based on preoperative cranial ultrasound. The second requirement was the development of an effective operative technique to perform both these procedures safely in our patients without a higher incidence of complications as compared with sequential surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

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

Wakhlu

Saxena

et al. 2009

Pediatr Neurosurg

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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.

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“…Because of the high incidence of hydrocephalus in these children, it is essential to closely monitor them for signs of ICH after the closure of MM 9,11,12,22,26 . Besides the LVA width measured slightly above the level of the thalami at the level of the choroid plexus, other criteria for hydrocephalus such as bifrontal diameter, bicaudate diameter, diameter of the body of the lateral ventricle, ventricular index, frontooccipital horn ratio, and thalamooccipital distance had already been studied in patients with MM and hydrocephalus 11,29 . Was not the aim of our study comparison between these methods and measures.…”

Section: Discussionmentioning

confidence: 99%

Clinical and ultrasonographic criteria for using ventriculoperitoneal shunts in newborns with myelomeningocele

Melo¹,

Pacheco²,

Melo³

et al. 2015

Arq. Neuro-Psiquiatr.

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Objective Hydrocephalus is one of the main complications associated with myelomeningocele (MM). This study aimed to identify clinical and ultrasonographic criteria for using ventriculoperitoneal (VP) shunts in this group of patients.Method A retrospective cohort study, based on established protocol for VP shunt implant in hydrocephalic children with MM. Parameters used to guide the indication of VP shunts included measurement of head circumference (HC), evaluation of fontanels, and measurement of lateral ventricular atrium (LVA) width by transcranial ultrasonography.Results 43 children were included in the analysis, of which 74% had hydrocephalus and required a VP shunt. These children had LVA width ≥ 15 mm, showed increased HC, or had bulging fontanels.Conclusion VP shunt is required in children with increased HC (≥ 2 standard deviation regarding age group), bulging fontanels, or LVA width of ≥ 15 mm after the closure of MM.

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The prediction of postoperative hydrocephalus in patients with spina bifida

Abstract: It is possible to predict the development of postoperative hydrocephalus in patients with spina bifida by measuring cranial ventricular dimensions using preoperative ultrasound.

Cited by 21 publications

References 2 publications

Reducing CSF shunt placement in patients with spinal myelomeningocele

Reducing CSF shunt placement in patients with spinal myelomeningocele

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

Clinical and ultrasonographic criteria for using ventriculoperitoneal shunts in newborns with myelomeningocele

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