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Shunt timing in meningomyelocele and clinical results: analysis of 80 cases

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Abstract

Purpose

Meningomyelocele is a serious pathology that requires immediate surgical treatment. Its management is difficult due to accompanying other pathologies and hydrocephalus. Shunt timing is still controversial. Therefore, this study retrospectively assessed 80 patients in order to improve the shunt timing and management of patients with meningomyelocele.

Methods

A total of 80 patients were followed up for 18–48 (average, 23) months. Patients were analyzed for the following variables: delivery method and time, head circumference monitoring, shunt timing, complication rates of patients who underwent shunting, during the early or follow-up period, accompanying pathologies, size, and localization of lesion.

Results

Patients including 46 males and 34 females have been operated. In 40% of patients, the accompanying pathology was determined. Approximately 85% of patients had hydrocephalus, and a ventriculoperitoneal shunt was placed on 36 symptomatic and 22 patients with hydrocephalus that developed during the follow-up. Differences in shunt-related and general complications were not significant between patients who underwent shunt placement during the same session and patients who underwent shunt placement during the follow-up. However, the incidence of cerebrospinal fluid fistula formation from the wound in patients who underwent shunt placement during the same session was significantly lower than those who underwent shunt placement during follow-up.

Conclusions

Immediate surgery (within the first 48 h) provides positive results, which is consistent with the existing literature. According to the logistic regression analysis, the placement of the meningomyelocele sac in the lumbosacral region is decisive in shunt insertion. Placing the shunt in the same session for patients with hydrocephalus and later for patients who developed hydrocephalus during the follow-up is recommended as a favorable treatment.

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Funding

This research did not receive any financial support from any person or institution.

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Authors and Affiliations

  1. Neurosurgery Department, Adana City Training and Research Hospital, Adana, Turkey

    İsmail İştemen, Ali Arslan, Semih Kıvanç Olguner, Vedat Açik, Ali İhsan Ökten & Mehmet Babaoğlan

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  1. İsmail İştemen
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  2. Ali Arslan
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  3. Semih Kıvanç Olguner
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  4. Vedat Açik
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  5. Ali İhsan Ökten
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  6. Mehmet Babaoğlan
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Contributions

Conception of the study: İsmail İştemen

Final approval of the version to be published: Ali İhsan Ökten

Drafting the work: İsmail İştemen, Ali Arslan, and Semih Kıvanç Olguner

Acquisition and analysis of data for the work: Vedat Açık and Mehmet Babaoğlan

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Correspondence to İsmail İştemen.

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The authors declare that they have no conflicts of interest.

Ethical approval

Ethical approval was obtained from the Clinical Research Ethics Committee of our Hospital for the study (479/19.06.2019).

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İştemen, İ., Arslan, A., Olguner, S.K. et al. Shunt timing in meningomyelocele and clinical results: analysis of 80 cases. Childs Nerv Syst 37, 107–113 (2021). https://doi.org/10.1007/s00381-020-04786-1

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  • DOI: https://doi.org/10.1007/s00381-020-04786-1

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