Department of Neurosurgery, Faculty of Medicine, Damascus University, Damascus, Syria.
Faculty of Medicine, Children's University Hospital CUH, Damascus University, Damascus, Syria.
Neurosurg Rev. 2024 Jul 20;47(1):343. doi: 10.1007/s10143-024-02576-w.
To discern the efficacy of simultaneous versus delayed VPS surgery in managing hydrocephalus linked with MMC repair: The debate over the concurrent or deferred placement of ventriculoperitoneal shunts (VPS) during myelomeningocele (MMC) repair in hydrocephalic neonates necessitates a nuanced evaluation of associated risks and benefits. While VPS placement can mitigate cerebrospinal fluid (CSF) leaks and minimize wound dehiscence post-MMC repair, it concurrently introduces potential hazards such as infections and shunt-related malfunctions. This prospective cohort study focused on144 newborns with spinal myelomeningocele and hydrocephalus. Divided into two groups based on the timing of dysraphism repair and VPS placement, 101 children underwent concurrent procedures, while 43 received deferred VPS insertion post-MMC closure. Female patients constituted 60% of the cohort, with lumbar lesions being predominant. The median age for MMC closure was three days. Analysis revealed that the deferred insertion group exhibited higher rates of shunt malfunctions, CSF leaks, and wound dehiscence compared to the concurrent insertion group. Although indications hinted at a potential increase in shunt infections in the immediate insertion group, statistical significance was lacking. The study established a statistically significant association between the timing of shunt insertion during MMC repair and specific outcomes, such as CSF leaks and wound dehiscence. The findings suggest that concurrent shunt insertion during MMC repair may reduce the incidence of these complications compared to deferred insertion. However, no substantial differences emerged in terms of shunt infection and malfunction, emphasizing the persistent challenges associated with these major complications.
探讨同期与延迟 VPS 手术治疗与 MMC 修复相关脑积水的疗效：在脑积水型脊髓脊膜膨出（MMC）新生儿的 MMC 修复过程中，同期或延迟放置脑室-腹腔分流管（VPS）的争议需要对相关风险和益处进行细致评估。虽然 VPS 放置可以减轻脑脊液（CSF）漏和最大限度减少 MMC 修复后的伤口裂开，但同时也会带来感染和分流相关故障等潜在危险。本前瞻性队列研究关注了 144 例脊髓脊膜膨出合并脑积水的新生儿。根据神经管畸形修复和 VPS 放置的时间，将患儿分为两组，101 例患儿行同期手术，43 例患儿在 MMC 关闭后行延迟 VPS 插入。队列中女性患者占 60%，以腰椎病变为主。MMC 关闭的中位年龄为 3 天。分析显示，与同期插入组相比，延迟插入组的分流故障、CSF 漏和伤口裂开发生率更高。尽管即时插入组的分流感染指征表明可能会增加，但统计学意义不显著。本研究确立了 MMC 修复过程中分流插入时间与特定结局（如 CSF 漏和伤口裂开）之间的统计学显著关联。研究结果表明，与延迟插入相比，同期行 MMC 修复时放置分流管可能会降低这些并发症的发生率。然而，在分流感染和故障方面没有出现实质性差异，这强调了与这些主要并发症相关的持续挑战。
