Shunt placement and myelomeningocele repair: simultaneous vs sequential shunting

Epstein, Nancy E.; Rosenthal, Alan D.; Zito, Joseph; Osipoff, Michael

doi:10.1007/bf00735728

Cited by 27 publications

(20 citation statements)

References 39 publications

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“…Epstein et al [16] were the first to advocate simulta neous closure and shunting of the infant born with my elomeningocele and overt hydrocephalus. Other authors have subsequently endorsed the selective simultaneous shunting of spina bifida infants with hydrocephalus [15][16][17][18][19][20], Several studies have noted that the spina bifida child presenting with hydrocephalus is more likely to have a higher sensory level and a larger myelomeningocele than the normocephalic spina bifida infant [15,16,19].…”

Section: Discussionmentioning

confidence: 99%

Contemporaneous Shunting with Repair of Myelomeningocele

Parent

McMillan²

1995

Pediatr Neurosurg

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The combination of overt hydrocephalus and an open myelomeningocele in a newborn has prompted some authors to advocate the repair of the myelomeningocele and the performance of a shunt procedure during the same anesthetic procedure. Advocates of this approach stress the merits of administering only one anesthetic, diminution in incidence of cerebrospinal fluid leaks from the repair, and shortened hospital stay and the resultant cost-effectiveness. This study was performed to assess the complication rate of shunts inserted at the time of myelomeningocele repair as well as of those inserted at a later date as a separate procedure. It would later appear that the insertion of a ventriculoperitoneal shunt, contemporaneous with the repair of the myelomeningocele, does not increase the risks of shunt infection or shunt malfunction within the 1st year of life.

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Section: Discussionmentioning

confidence: 99%

Contemporaneous Shunting with Repair of Myelomeningocele

Parent

McMillan²

1995

Pediatr Neurosurg

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“…For patients with frank hydrocephalus, concurrent placement of a shunt at the time of myelomeningocele repair is considered safe and seems to not increase the rate of complications. 3,14,21,29,42 For patients with asymptomatic ventriculomegaly at birth, the timing of shunt placement is controversial. Some have suggested that a watch-and-wait strategy may reduce the overall rate of shunting in this group, but the risk for CSF leakage from the surgical repair site might be increased.…”

Section: Hydrocephalusmentioning

confidence: 99%

Myelomeningocele: surgical trends and predictors of outcome in the United States, 1988–2010

Kshettry

Kelly

Rosenbaum

et al. 2014

PED

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Object Myelomeningocele repair is an uncommonly performed surgical procedure. The volume of operations has been decreasing in the past 2 decades, probably as the result of public health initiatives for folate supplementation. Because of the rarity of myelomeningocele, data on patient or hospital factors that may be associated with outcome are scarce. To determine these factors, the authors investigated the trends in myelomeningocele surgical repair in the United States over a 23-year period and examined patient and hospital characteristics that were associated with outcome. Methods The Nationwide Inpatient Sample database for 1988–2010 was queried for hospital admissions for myelomeningocele repair. This database reports patient, hospital, and admission characteristics and surgical trends. The authors used univariate and multivariate logistic regression to assess associations between patient and hospital characteristics and in-hospital deaths, nonroutine discharge, long hospital stay, and shunt placement. Results There were 4034 hospitalizations for surgical repair of myelomeningocele. The annual volume decreased since 1988 but plateaued in the last 4 years of the study. The percentages of myelomeningocele patients with low income (30.8%) and Medicaid insurance (48.2%) were disproportionately lower than those for the overall live-born population (p < 0.0001). More operations per 10,000 live births were performed for Hispanic patients (3.2) than for white (2.0) or black (1.5) patients (p < 0.0001). Overall, 56.6% of patients required shunt placement during the same hospital stay as for surgical repair; 95.0% of patients were routinely discharged; and the in-hospital mortality rate was 1.4%. Nonwhite race was associated with increased in-hospital risk for death (OR 2.8, 95% CI 1.2–6.3) independent of socioeconomic or insurance status. Conclusions Overall, the annual surgical volume of myelomeningocele repairs decreased after public health initiatives were introduced but has more recently plateaued. The most disproportionately represented populations are Hispanic, low-income, and Medicaid patients. Among nonwhite patients, increased risk for in-hospital death may represent a disparity in care or a difference in disease severity.

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“…Many authors have suggested the repair of MM and shunt insertion during same session (4,10,12,20). According to them, in patients with HCP and MM, insertion of shunt in same session would provide a swift recovery of back, avoid a second operation, protect the brain from deterious effects of progressive HCP resulting from delayed shunting and decrease duration of hospitalization (7,10,15,20,23). However, there is also an opposite view; concurrent shunt surgery, in same session, may cause an increased shunt infection risk, which is a common complication of shunting in the patients with MM, observed between the rates of 2-39% (18), because ventricular shunt placement reverses cerebrospinal fluid (CSF) flow from the lumbar region to ventricles (3,9,18).…”

Section: Introductionmentioning

confidence: 99%

Comparison of simultaneous shunting to delayed shunting in infants with myelomeningocele in terms of shunt infection rate

Arslan¹,

Eşeoğlu²,

Güdü³

et al. 2011

Turkish Neurosurgery

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AIm: Timing of shunt insertion in infants with myelomeningocele (MM) and hydrocephalus (HCP) has been debated. Many authors have suggested to perform the repair of MM and shunt insertion during same operation. However, there is also an opposite view. mAterIAl and methOds:We analyzed retrospectively 166 patients who underwent MM Sac repair to evaluate whether there are difference between these two methods in terms of shunt infection rate. results:In the same session, V-P (ventriculoperitoneal) shunt placement was performed onto 65 infants within the first 48 hours of postnatal and 36 infants were operated 48 hours after birth. In separate sessions, repair of MM were performed onto 29 infants within the first 48 hours of postnatal and shunting was peformed 7 days after sac repair. 14 infants were performed MM sac repair 48 hours after birth, then shunt was applied 7 days after closure of MM. Shunt infection rate in concurrently operated groups was markedly high (12.3 % in early surgery, 33.3% in late surgery); in separatedly operated groups' shunt infection rate was lower (3.44% in early surgery, 14.29% in late surgery). COnClusIOn:We propose to perform V-P shunt placement and MM repair in separate sessions. BulGulAr: Yaşamın ilk 48 saat içinde 65 infanta aynı seansda şant yerleştirilmesi ve myelomeningosel tamiri yapıldı ve doğumdan 48 saat sonra (3 ile 7 gün arasında) 36 infanta yine aynı seansda şant yerleştirilmesi ve kese tamiri yapıldı. Ayrıca yaşamın ilk 48 saat içinde 29 infanta myelomeningosel tamiri yapıldı ve ortalama 7 gün sonra ayrı bir seansda şant takıldı. 14 infanta myelomeningosel tamiri yapıldı doğumdan 48 saat sonra (doğumdan sonra 3 ile 7 gün arasında) ve kese tamirinde 7 gün sonra şant takıldı. Şant infeksiyon oranı aynı anda ameliyat edilen grupta belirgin olarak yüksekti (erken cerrahi yapılan grupta: %12.3, Geç cerrahi yapılan grupta: %33.3). Ayrı seanslarda ameliyat edilen grupta şant infeksiyon oranı düşüktü (erken cerrahi yapılan grupta: %3.44, geç cerrahi yapılan grupta: %14.29).sOnuÇ: Sonuç olarak biz ayrı seanslarda myelomeningosel kese tamiri ve şant yerleştirilmesini öneriyoruz.

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Shunt placement and myelomeningocele repair: simultaneous vs sequential shunting

Cited by 27 publications

References 39 publications

Contemporaneous Shunting with Repair of Myelomeningocele

Contemporaneous Shunting with Repair of Myelomeningocele

Myelomeningocele: surgical trends and predictors of outcome in the United States, 1988–2010

Comparison of simultaneous shunting to delayed shunting in infants with myelomeningocele in terms of shunt infection rate

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