COMPARISON OF SIMULTANEOUS VERSUS DELAYED VENTRICULOPERITONEAL SHUNT INSERTION IN CHILDREN UNDERGOING MYELOMENINGOCELE REPAIR

The timing of cerebrospinal fluid shunt insertion for those neonates w ith hydrocephalus in association with myelomeningocele remains controv ersial. To examine whether there was a difference in either the compli cation rate or mean hospital stay for neonates undergoing myelomeningo cele repair and shunting under the same anesthetic (simultaneous group ) versus those in whom shunt insertion was delayed for several days af ter myelomeningocele closure (sequential group), we reviewed the resul ts obtained with these two approaches in a series of 69 consecutive pa tients who underwent both myelomeningocele closure and shunt insertion at our institution between 1987 and 1993. Twenty-one infants underwen t simultaneous myelomeningocele repair and shunting, and 48 underwent sequential procedures. The decision to shunt con currently with myelom eningocele repair rather than in a delayed fashion was based primarily on surgeon preference rather than initial head circumference, which d id not differ significantly between the two groups. The frequency and type of hydrocephalus-related complications (eg, wound leak, cerebrosp inal fluid infection, or shunt malfunction) that occurred during the f irst 6 months after myelomeningocele closure were compared between the two groups. Neither the overall frequency of complications nor the fr equency of cerebrospinal fluid infection, shunt malfunction, or sympto matic Chiari malformation differed significantly between the two group s. In contrast, there was a significantly higher rate of myelomeningoc ele wound leak in the sequential group versus the simultaneous group ( eight versus zero; P = .05). Mean hospital stay for the sequential gro up was also significantly longer than the simultaneous group (22 days versus 13 days; P = .05). These results suggest that simultaneous myel omeningocele repair and ventriculoperitoneal shunt insertion reduces h ospital stay and back wound morbidity in those patients with evidence of hydrocephalus at birth, without an inordinate increase in shunt-rel ated complications.