Turkish Neurosurgery
Does shunt selection affect the rate of early shunt complications in neonatal myelomeningocele-associated hydrocephalus? -a multi-center report-
Gokmen Kahilogullari1, Volkan Etus2, Guler Tugba Moralı3, Karabagli Hakan4, Unlu Agahan1
1Ankara University, Department of Neurosurgery, Ankara,
2Kocaeli University, Department of Neurosurgery, Kocaeli,
3Karabuk University, Educational and Research Hospital, Department of Neurosurgery, Karabuk,
4Selcuk University, Department of Neurosurgery, Konya,
DOI: 10.5137/1019-5149.JTN.18547-16.1
Aim:To evaluate the effect of shunt selection on the rate of shunt revision due to early shunt com-plications in neonatal myelomeningocele-associated hydrocephalus.Material and Methods:The data of a total of 157 neonatal myelomeningocele cases in three pediatric neurosurgery centers (Ankara University, Kocaeli University, Selcuk University) who underwent shunt surgery at the time of myelomeningocele repair between 2000 and 2014 were retrospectively analyzed. Clinical features of the patients shunt types used, and early shunt complications within the first three months were recorded. The patients were classified according to several features of the shunt systems used, such as the valve type, valve size/contour and catheter type.Results:Of all patients, 71 (45.2%) underwent early shunt revision surgery due to various complications. Mechanical complications were the most frequent cause of shunt failure, followed by infection. There was no significant difference among valve types. Also, no significant difference was observed among the catheter types. Only preferred valve contour/size (contoured regular /ultra-small / burr-hole / cylindrical / neonatal) seemed to significantly affect the rate of early complications. The patients with neonatal-design valves or ultra-small valves had significantly less problems, such as poor wound-healing, wound-dehiscence, cerebrospinal fluid leak or an exposed-shunt. The infection rate due to such problems was found to be lower.Conclusion:myelomeningocele patients with prominent hydrocephalus frequently have a friable skin, due to reduced macrocrania-related subcutaneous tissues. Our study findings suggest that using small-sized (neonatal-design or ultra-small) valves may significantly reduce the early shunt complication rate in this patient population.
Corresponding author : Gokmen Kahilogullari