Experience with simultaneous ventriculo-peritoneal shunt placement and myelomeningocele repair.

A program evaluating simultaneous shunt placement and neural tube repair is described and compared with a concomitant series of patients whose surgeons preferred delayed shunting. Twenty-two patients had simultaneous closure of neural tube defects and placement of ventriculoperitoneal shunts; one was shunted 1 day prior to closure of a leaking myelomeningocele. Eleven other patients had closure of myelomeningoceles followed by shunting 6 to 14 days later. Four patients have not required shunting. Three patients needed complex flap rotations and silastic dural closures, but the complexity of the myelomeningocele closure was not a criterion for excluding simultaneous shunting. The only criteria were preference of the attending surgeon, and ventricular size. All but one in the simultaneous shunting (SS) group had moderate to marked hydrocephalus at birth; one initially selected not to have a shunt, but within 24 hours had marked increase in ventricular size by ultrasonography performed when the child was anesthetized for the myelomeningocele closure. In the SS group, surgical innovations included (1) use of the semilateral position for exposure of both operative sites for shunting and the myelomeningocele closure, (2) posteriorly-placed subcutaneous peritoneal catheter, and (3) a combined surgical approach using two surgeons and separate instrumentation. There was no operative mortality in either group; there were no infections within 30 days in either group. There was one infection at 5 months in the SS group, and one at 2 months in the delayed shunting (DS) group; the long-term infection rate was 5%, comparable to any published series.(ABSTRACT TRUNCATED AT 250 WORDS)