Shunt revision rates in myelomeningocele patients in the first year of life: a retrospective study of 52 patients
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Shunt placement indications are stringent and require confirmation of clinical and radiological evidence of hydrocephalus (HC). The aim of this study was to determine the rate of shunting and discuss the outcome in the first year of life in patients with myelomeningocele (MMC) on the basis of review of the literature.
All patients who underwent postnatal repair of MMC at our institution between March 2014 and March 2015 were evaluated. Patients were only included if they underwent both MMC repair and ventriculoperitoneal (VP) shunt insertion at our institution and were followed up for at least 12 months. The mean ages for repair of MMC, MMC levels, timing of VP shunt placement, shunt revisions, and causes of shunt revisions were documented.
Fifty-two patients with MMC were included in this study. The average gestational age at birth was 38 weeks. The level of MMC was thoracolumbar in 13 cases, 11 times lumbar, 21 times lumbosacral, and 7 times sacral. Thirty-one patients (59.61%) suffered from hydrocephalus and required placement of a shunt. When we evaluate the lesion levels of patients who require shunting, 13 cases were thoracolumbar, 6 cases were lumbar, and 11 cases were lumbosacral. None of the sacral cases needed VP shunt. Seven patients (13.4%) had shunt revision within the first year of life. The cause of shunt revision was wound problem in one patient (1.9%), underdrainage in two patients (3.8%), infection in three patients (5.7%), and mechanical obstruction in another one patient (1.9%).
MMC closure and management of the associated HC are one of the most basic, but never simple, legs of the pediatric neurosurgery around the world. As clinicians and neurosurgeons, we are obligated to analyze recent evidences and evaluate present approaches to achieve optimization in this subject until further technologies or approaches became more advantageous for our patients.
KeywordsHydrocephalus Myelomeningocele Shunt Revision
Compliance with ethical standards
Conflict of interest
There are no conflicts of interest.
- 2.Botto LD, Lisi A, Robert-Gnansia E, Erickson JD, Vollset SE, Mastroiacovo P, Botting B, Cocchi G, de Vigan C, de Walle H, Feijoo M, Irgens LM, McDonnell B, Merlob P, Ritvanen A, Scarano G, Siffel C, Metneki J, Stoll C, Smithells R, Goujard J (2005) International retrospective cohort study of neural tube defects in relation to folic acid recommendations: are the recommendations working? BMJ 330(7491):571–570. https://doi.org/10.1136/bmj.38336.664352.82 CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Rintoul NE, Sutton LN, Hubbard AM, Cohen B, Melchionni J, Pasquariello PS, Adzick NS (2002) A new look at myelomeningoceles: functional level, vertebral level, shunting, and the implications for fetal intervention. Pediatrics 109(3):409–413. https://doi.org/10.1542/peds.109.3.409 CrossRefPubMedGoogle Scholar
- 6.Adzick NS, Thom EA, Spong CY, Brock JW 3rd, Burrows PK, Johnson MP, Howell LJ, Farrell JA, Dabrowiak ME, Sutton LN et al (2011) A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 364(11):993–1004. https://doi.org/10.1056/NEJMoa1014379 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Sinha SK, Dhua A, Mathur MK, Singh S, Modi M, Ratan SK (2012) Neural tube defect repair and ventriculoperitoneal shunting: indications and outcome. J Neonatal Surgery 1(2):21Google Scholar
- 17.Januschek E, Rohrig A, Kunze S, Fremerey C, Wiebe B, Messing-Junger M (2016) Myelomeningocele—a single institute analysis of the years 2007 to 2015. Child’s Nervous System: ChNS: Official J Int Society Pediatric Neurosurgery 32(7):1281–1287. https://doi.org/10.1007/s00381-016-3079-1 CrossRefGoogle Scholar
- 19.Hanak BW, Bonow RH, Harris CA, Browd SR (2017) Cerebrospinal fluid shunting complications in children. Pediatr Neurosurg. https://doi.org/10.1159/000452840
- 24.Riva-Cambrin J, Kestle JR, Holubkov R, Butler J, Kulkarni AV, Drake J, Whitehead WE, Wellons JC 3rd, Shannon CN, Tamber MS et al (2016) Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study. J Neurosurg Pediatr 17(4):382–390. https://doi.org/10.3171/2015.6.PEDS14670 CrossRefPubMedGoogle Scholar
- 25.Drake JM, Kestle JR, Milner R, Cinalli G, Boop F, Piatt J Jr, Haines S, Schiff SJ, Cochrane DD, Steinbok P et al (1998) Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 43(2):294–303; discussion 303-295. https://doi.org/10.1097/00006123-199808000-00068 CrossRefPubMedGoogle Scholar
- 27.Pedreira DA, Zanon N, de Sa RA, Acacio GL, Ogeda E, Belem TM, Chmait RH, Kontopoulos E, Quintero RA (2014) Fetoscopic single-layer repair of open spina bifida using a cellulose patch: preliminary clinical experience. J Maternal-Fetal & Neonatal Medicine : Official J European Association Perinatal Medicine, Federation Asia Oceania Perinatal Societies, Int Society Perinatal Obstet 27(16):1613–1619. https://doi.org/10.3109/14767058.2013.871701 CrossRefGoogle Scholar
- 28.Tulipan N, Wellons JC 3rd, Thom EA, Gupta N, Sutton LN, Burrows PK, Farmer D, Walsh W, Johnson MP, Rand L et al (2015) Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement. J Neurosurg Pediatr 16(6):613–620. https://doi.org/10.3171/2015.7.PEDS15336 CrossRefPubMedPubMedCentralGoogle Scholar