Clinical and ultrasonographic criteria for using ventriculoperitoneal shunts in newborns with myelomeningocele

Melo, José Roberto Tude; Pacheco, Pollyana; Melo, Emília Nunes de; Vasconcellos, Ângela G.; Passos, Rosane Klein

doi:10.1590/0004-282x20150110

Cited by 13 publications

(3 citation statements)

References 26 publications

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“…In unserem Patientenkollektiv waren 74,4 % der Patienten mit einem Shunt versorgt. Die Angaben in der Literatur lagen zwischen 74 und 86 % [10,18,19].…”

Section: Shuntversorgungunclassified

Orthotic Care Based on the Ferrari Concept for Children and Adults with Meningomyelocele

et al. 2019

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Background Even today, myelomeningocele (MMC) is still encountered in clinical medicine and its incidence has not decreased over the last 20 years despite a known reduction in risk due to the use of folic acid supplements. The spectrum of clinical symptoms is extremely broad and, depending on the level of the defect, varies from mild to severe. Subject to the degree of paralysis, patients are reliant on the use of orthopaedic aids and orthoses for the treatment of primary contractures and deformities and the prevention of secondary ones. This forms the basis for attaining or maintaining mobility in many patients. The objective of the study was to determine the practical application of the proposed Ferrari concept for the provision of orthoses for children and adults. Patients and Material The retrospective study comprised medical records of 180 patients (97 m) with an average age of 19.44 years (3 – 52 years, SD 9.3) at the time of investigation. The average duration of treatment was 15.34 years (1 – 38 years, SD 8.96). Data relating to deformities of the vertebral column and lower limbs, provision of hydrocephalus shunts and orthoses, and patient mobility was evaluated. Results Most patients were given systematic treatment with orthoses at an early stage. In 58,9% of cases, it was possible to implement the proposed concept for providing patients with dynamic orthoses, whereby the treatment concept was more difficult to implement with high lumbar lesions than with lower lesions. Moreover, a decrease in the patientsʼ mobility with increasing age was noticeable. Some 42.3% of adult patients were able to walk with marked variations in mobility in relation to the different levels of lesions. Conclusion Taking into consideration the complexity of both the clinical picture and therefore the provision of orthopaedic devices, the result of the implementation of the proposed orthotic concept can be considered positive. Similarly, early commencement of provision of orthoses and hence the possibility of achieving a positive influence on later mobility can be considered a success. The need for individual concepts and further development in order to increase mobility particularly in the case of patients with thoracic or high lumbar lesions is evident. A more comprehensive provision of information to patients regarding orthotic treatment options and their consequences for prophylaxis and quality of life should be an important component of interdisciplinary long-term patient care.

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“…In unserem Patientenkollektiv waren 74,4 % der Patienten mit einem Shunt versorgt. Die Angaben in der Literatur lagen zwischen 74 und 86 % [10,18,19].…”

Section: Shuntversorgungunclassified

Orthotic Care Based on the Ferrari Concept for Children and Adults with Meningomyelocele

et al. 2019

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“…The CSF drainage is commonly indicated in cases of progressive increases in cranial circumference (≥ 2 standard deviations above the patient' s age group during the first week), bulging fontanelles, or changes in respiratory patterns, associated with progressive widening of the ventricular system detected by transcranial ultrasonography 13,17,18 . In cases of ventriculomegaly from ex vacuo hydrocephalus (i.e.…”

Section: Surgical Interventionmentioning

confidence: 99%

Cerebrospinal fluid drainage options for posthemorrhagic hydrocephalus in premature neonates

Melo¹,

Passos²,

Carvalho³

2017

Arq. Neuro-Psiquiatr.

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Objective: The literature describes various cerebrospinal fluid (CSF) drainage techniques to alleviate posthemorrhagic hydrocephalus in preterm newborns; however, consensus has not been reached. The scope of this study was describing a case series of premature neonates with posthemorrhagic hydrocephalus and assessing the outcomes of different approaches used for CSF diversion. Methods: A consecutive review of the medical records of neonates with posthemorrhagic hydrocephalus treated with CSF drainage was conducted. Results: Forty premature neonates were included. Serial lumbar puncture, ventriculosubgaleal shunt, and ventriculoperitoneal shunt were the treatments of choice in 25%, 37.5% and 37.5% of the cases, respectively. Conclusion: Cerebrospinal fluid diversion should be tailored to each case with preference given to temporary CSF drainage in neonates with lower age and lower birth-weight, while the permanent ventriculoperitoneal shunt should be considered in healthier, higher birth-weight neonates born closer to term.Keywords: cerebral hemorrhage; hydrocephalus; cerebrospinal fluid. RESUMOObjetivo: A literatura descreve várias opções de drenagem liquórica (DL) para alivio da hidrocefalia pós-hemorrágica (HPH) em neonatos prematuros; contudo, não existe um consenso sobre a melhor abordagem. O escopo deste estudo foi descrever uma série de casos de neonatos prematuros, portadores de HPH, verificando os resultados de diferentes técnicas utilizadas para DL. Métodos: Revisão consecutiva dos prontuários de neonatos com diagnostico de HPH submetidos a DL. Resultados: Quarenta recém-nascidos prematuros foram incluídos. A punção lombar seriada (PL), a derivação ventriculosubgaleal (VSG) e a derivação ventrículo peritoneal (VP) foram o tratamento escolhido em 25%, 37,5% e 37,5% dos casos, respectivamente. Conclusão: As opções de DL devem ser avaliadas caso a caso, sendo dada preferência às drenagens temporária em prematuros com idade e peso mais baixos ao nascer, enquanto o shunt definitivo (derivação VP) pode ser considerado naqueles prematuros mais saudáveis, com idade e peso superiores.Palavras-chave: hemorragia cerebral; hidrocefalia; líquido cefalorraquidiano. Intraventricular hemorrhage (IVH) has been a major cause of mortality among premature neonates for more than 40 years 1,2 and is associated with neonatal encephalopathy, subsequent subtle apnea, and death 1,2,3,4 . Low birth-weight premature neonates are more vulnerable to IVH and, depending on the IVH grade, to posthemorrhagic hydrocephalus (PHH). Posthemorrhagic hydrocephalus can evolve to progressive PHH, and in more severe cases, to periventricular hemorrhagic infarct, hemorrhagic cerebral injury, and periventricular leukomalacia 1,4,5 . Between 15% to 20% of neonates born with a weight less than 1,500 g are estimated to develop IVH. Further, 75% of those with Papile grade III or IV hemorrhages develop progressive PHH and need a permanent shunt 4,6 .The literature does not clearly indicate any standardized protocols for the best PHH treatment o...

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“…Eighty to 90% of patients with MMC have historically required permanent CSF diversion for treatment of hydrocephalus [1,[6][7][8]. This number has been reduced in the recent past through the acceptance of macrocephaly and ventriculomegaly in the absence of symptoms of hydrocephalus or Chiari II malformation; whether there are negative consequences to this higher shunting threshold remains to be seen [9,10] Up to 18% of patients experience wound complications, including dehiscence, pseudomeningocele formation, CSF leak, and infection, that have negative effects on outcomes and significantly increase the length of hospital stay [1].…”

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confidence: 99%

The Use of External Ventricular Drainage to Reduce the Frequency of Wound Complications in Myelomeningocele Closure

et al. 2018

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Introduction: Myelomeningocele (MMC) is an open neural tube defect routinely surgically closed within 48 h of birth to prevent secondary infection. Up to 18% of patients experience wound complications, and 85% require shunting for hydrocephalus. We hypothesized that wound complications could be reduced by cerebrospinal fluid (CSF) diversion at the time of closure. Methods: Institutional review board approval was obtained to review records of the 88 patients who underwent MMC closure between January 2005 and June 2016 at the Children's Hospital of Pittsburgh. Twenty-three patients (26%) had an external ventricular drain (EVD) placed at the time of MMC closure and underwent 7-11 days of CSF drainage. Fourteen patients (16%) had a shunt placed at the time of MMC closure, and 51 (58%) had no form of CSF diversion at the time of MMC closure. Results: Patients with an EVD or shunt placed at the time of closure had no wound complications. In contrast, 8 patients (16%) without CSF diversion at closure developed wound complications (p = 0.048). Seven of the 8 wound complications occurred in the 71 patients with evidence of hydrocephalus at birth (p = 0.98). Of patients with evidence of hydrocephalus at the time of MMC closure, wound complications had a higher rate of occurrence among patients who did not receive a shunt or EVD at closure (p = 0.01). When comparing only patients with evidence of hydrocephalus at birth, the EVD group alone had a lower rate of wound complications than patients who did not receive CSF diversion at the time of closure (p = 0.031). Conclusions: These results suggest that addressing hydrocephalus at the time of MMC closure significantly reduces the likelihood of wound complications and may justify temporary CSF diversion at birth, at least in those patients manifesting hydrocephalus.

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Clinical and ultrasonographic criteria for using ventriculoperitoneal shunts in newborns with myelomeningocele

Cited by 13 publications

References 26 publications

Orthotic Care Based on the Ferrari Concept for Children and Adults with Meningomyelocele

Orthotic Care Based on the Ferrari Concept for Children and Adults with Meningomyelocele

Cerebrospinal fluid drainage options for posthemorrhagic hydrocephalus in premature neonates

The Use of External Ventricular Drainage to Reduce the Frequency of Wound Complications in Myelomeningocele Closure

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