Does combining the placement of a ventriculoperitoneal shunt and repairing a myelomeningocele in new-borns impact the occurrence of complications?

Abstract

Abstract Introduction: The use of ventriculoperitoneal shunt placement and myelomeningocele (MMC) repair together in hydrocephalic neonates is a topic of ongoing debate and requires careful consideration of the potential risks and benefits. On the one hand, this procedure can prevent the development of cerebrospinal fluid (CSF) leaks after MMC repair and reduce the risk of infections. On the other hand, it can increase the risk of infection and shunt-related malfunction. Therefore, the decision to perform this procedure should be based on a thorough assessment of the individual patient's condition and associated risks. Materials and Methods: This is a retrospective cohort study that analyzed 144 new-borns with spinal myelomeningocele and hydrocephalus. Certain patients were excluded based on specific criteria. The diagnosis of hydrocephalus was based on various techniques. The patients were divided into two groups according to when dysraphism repair and ventriculoperitoneal shunt placement were performed. The study analyzed complications related to the hydrodynamics of the CSF in the two groups to determine the optimal timing to treat MMC-associated hydrocephalus. Results: 101 children receiving simultaneous insertion of the ventriculoperitoneal shunt (VP) during myelomeningocele closure, and 43 children receiving delayed insertion of the VP shunt after myelomeningocele closure. Females represented 60% of the patients, and lumbar lesions were the most common. The median age for myelomeningocele closure was 4 days. The deferred insertion group had a higher proportion of shunt malfunctions, CSF leaks, and dehiscence than the simultaneous insertion group. There was evidence to suggest that the simultaneous insertion group may have a higher proportion of shunt infections, but the difference was not statistically significant. The study found a statistically significant association between the timing of the insertion of the VP shunt and complications, but further analysis is necessary to determine which approach is more appropriate for each patient. Conclusion: In summary, a study has found that there is a significant relationship between the timing of shunt insertion during MMC repair surgery and the occurrence of certain outcomes such as shunt malfunction, CSF leak, and dehiscence. The study suggests that the simultaneous insertion of the shunt with MMC repair may result in lower rates of these results compared to the delay in shunt insertion until after MMC repair. However, there are no significant differences between the two groups for the occurrence of shunt infection, which remains a major complication.