Phillips Blake C, Gelsomino Michael, Pownall Ambre' L, Ocal Eylem, Spencer Horace J, O'Brien Mark S, Albert Gregory W
Departments of Neurosurgery and.
J Neurosurg Pediatr. 2014 Aug;14(2):167-72. doi: 10.3171/2014.4.PEDS13470. Epub 2014 May 30.
Many patients with myelomeningocele (MMC) develop hydrocephalus, and most will undergo CSF diversion. The goal of this retrospective study was to determine whether there was a change in the shunt rate over the 7 consecutive years of the study. The authors will also identify the criteria used to determine the need for shunt placement.
During a 7-year period, 73 patients underwent MMC closure at Arkansas Children's Hospital. The shunt rate for each year was calculated. Clinical characteristics were evaluated, including apneic and bradycardic spells, CSF leak, level of the MMC, head circumference, and rate of head growth. In addition, radiological images were reviewed, and the frontooccipital horn ratio (FOHR), ventricular index (VI), and thalamooccipital distance (TOD) were calculated. Comparisons were made between those patients who underwent shunt placement and those who did not.
One patient was excluded due to death in the perinatal period. Of the 72 remaining patients, 54 (75%) underwent placement of a ventriculoperitoneal shunt. This rate did not change significantly over time. Between the cohorts with and without a shunt there was no significant difference in age, sex, or race. There was no significant difference in apneic episodes or bradycardic episodes. There was a statistically significant difference in fontanelle characteristics, head circumference at birth, and rate of head growth. Patients who required CSF diversion had a mean head growth of 0.32 cm/day compared with those who did not receive a shunt (0.13 cm/day; p < 0.05). All radiological parameters were found to be statistically significant.
In this study, several classic indicators of hydrocephalus in the neonate were not found to be significantly associated with the need for CSF diversion. Fontanelle characteristics, head circumference at birth, and head growth velocity were associated with the need for shunt placement. Imaging information including the VI, TOD, and FOHR are statistically significant measures to evaluate prior to placement of a ventriculoperitoneal shunt. The optimal patient with MMC for CSF diversion will have full to tense fontanelle, increasing head circumference of more than 3 mm/day, and radiological evidence of an elevated VI, TOD, and/or FOHR.
许多脊髓脊膜膨出（MMC）患者会发生脑积水，且大多数患者需要进行脑脊液分流术。这项回顾性研究的目的是确定在该研究连续7年期间分流率是否有变化。作者还将确定用于判定是否需要放置分流管的标准。
在7年期间，73例患者在阿肯色州儿童医院接受了MMC修复术。计算每年的分流率。评估临床特征，包括呼吸暂停和心动过缓发作、脑脊液漏、MMC的水平、头围和头生长速率。此外，回顾放射影像，计算额枕角比（FOHR）、脑室指数（VI）和丘脑枕距离（TOD）。对接受分流管放置的患者和未接受分流管放置的患者进行比较。
1例患者因围产期死亡被排除。在其余72例患者中，54例（75%）接受了脑室腹腔分流管放置。该比率随时间未发生显著变化。有分流管和无分流管的队列在年龄、性别或种族方面无显著差异。呼吸暂停发作或心动过缓发作无显著差异。囟门特征、出生时头围和头生长速率存在统计学显著差异。需要脑脊液分流的患者平均头生长速率为每天0.32厘米，而未接受分流管的患者为每天0.13厘米（p<0.05）。所有放射学参数均具有统计学显著性。
在本研究中，未发现新生儿脑积水的几个经典指标与脑脊液分流的需求显著相关。囟门特征、出生时头围和头生长速度与分流管放置的需求相关。包括VI、TOD和FOHR在内的影像信息是在放置脑室腹腔分流管之前进行评估的具有统计学显著性的指标。适合脑脊液分流的最佳MMC患者将有饱满至紧张的囟门、头围每天增加超过3毫米，以及VI、TOD和/或FOHR升高的放射学证据。
