Single-stage treatment of spina bifida with hydrocephalus based on a prediction rule derived from preoperative cranial ultrasound.
OBJECTIVE
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.
Wakhlu
Ashish
A
Department of Pediatric Surgery, King George Medical University, Lucknow, India. ashish_wakhlu@hotmail.com
Wakhlu
Geeta
G
Saxena
Sunita
S
Tandon
R K
RK
D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D012886:Skull / Q000000981:diagnostic imaging; D016135:Spinal Dysraphism / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D014463:Ultrasonography