title: Shunt insertion in newborns with myeloschisis/myelomenigocele and hydrocephalus.
abstract: We compared two strategies for treating newborns with myeloschisis or myelomeningocele (open neural tube defect [oNTD]) and hydrocephalus. These strategies involved insertion of a ventriculo-peritoneal shunt (VPS) either synchronous with or sequential to surgical closure of the oNTD. We investigated shunt infection and cerebrospinal fluid (CSF) leakage rates and their effects on the duration of hospitalization for both treatments. The study involved 65 patients with hydrocephalus and open neural placodes which were covered with a thin pseudomembrane. Thirty-eight infants underwent an oNTD repair operation and shunting during the same surgical session (synchronous group [group 1]), and 27 infants underwent sequential procedures, in which shunt insertion was delayed until the thoracolumbar wound was partially healed (sequential group [group 2]). Group 1 had a mean duration of hospital stay of 15.5 days, significantly less than the average 28.8 days of group 2 (p < 0.05). No significant differences in CSF leakage and shunt infections occurred between the two groups (p > 0.05). The incidence of shunt infection due to CSF fistulas that developed postoperatively was higher for patients with CSF leakage as a result of oNTD at birth than for patients without CSF leakage (p < 0.05). Patients with oNTD are at significant risk of infections because of the thin pseudomembrane over the defect. In addition, newborn patients may also have a weakened immune system. Despite these disadvantages, VPS placement within a single session can be advantageous for the patient, family and physician, compared to multiple surgical procedures. It is also more cost-effective.
authors.affiliation: Neurosurgery Clinic, Şişli Etfal Education and Research Hospital, Şişli, İstanbul 34077, Turkey.
authors.forename: Adem
authors.initials: A
authors.lastname: Yilmaz
authors.forename: Ahmet Murat
authors.initials: AM
authors.lastname: Müslüman
authors.forename: Nazan
authors.initials: N
authors.lastname: Dalgic
authors.forename: Halit
authors.initials: H
authors.lastname: Cavuşoğlu
authors.forename: Ayhan
authors.initials: A
authors.lastname: Kanat
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Colak
authors.forename: Yunus
authors.initials: Y
authors.lastname: Aydın
mesh_terms: D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D007231:Infant, Newborn; D008591:Meningomyelocele / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects