Clinical Outcomes and Complication Rates of Ventriculoperitoneal Shunts in Hydrocephalic Infants with Meningomyelocele: A Ten-Year Review at a Single Institution.

BACKGROUND/OBJECTIVES: This study aimed to investigate the surgical treatment and management of hydrocephalus in infants with meningomyelocele and compare the single-center experience with the previous studies.

METHODS

This retrospective study included 81 infants (47 females and 34 males) who underwent meningomyelocele closure surgery and subsequent ventriculoperitoneal (VP) shunt surgery for hydrocephalus. Clinical and demographic data were retrospectively collected from hospital records, focusing on variables such as the timing of VP shunt placement relative to MMC closure, postoperative complications, and the need for shunt revisions. Patients were followed for a mean duration of 58.11 months to monitor long-term outcomes and identify factors associated with shunt failures and infections.

RESULTS

The mean follow-up period since birth was 58.11 (33.72) months. Shunt problems affected 30% (25/81) of patients with mechanical causes (8/25) and infections (6/25). A proximal mechanical malfunction/dysfunction was seen in 32% (8/25) of the shunts. Shunt infections occurred in 23% (19/81) of infants, and the mean time for shunt infection onset following the VP shunt procedure was 0 (0-39) median (min-max) months. Overall, 8 (9.9%) infants had short-term shunt infections, whereas 11 (13.6%) had long-term shunt infections. The mean length of the intensive care unit stay was 35.75 (25.28) days. Significant difference was seen in the number of shunt reoperations for short- and long-term infections ( < 0.001). All infants had at least one operation before the infection of their shunt system. Male gender was significantly associated with long-term shunt infections ( = 0.021). The study revealed methicillin-resistant coagulase-negative staphylococcus to be the most common isolated organism from infected shunts at 72.7% (6/11).

CONCLUSIONS

This study demonstrates that hydrocephalic infants with meningomyelocele undergoing VP shunt surgery face notable risks of infection and mechanical complications, with methicillin-resistant coagulase-negative staphylococcus identified as the most common pathogen. The findings emphasize the importance of comprehensive postoperative care and targeted infection management to improve outcomes in this vulnerable population.