A Systematic Review for Simultaneous versus Delayed Ventriculo-Peritoneal Shunting in Surgical Repair of Meningomyelocele sac in Patients with Chiari Type II Malformation

Abstract

Background The management of MMC-associated hydrocephalus has evolved over time. Many consultants now preferring to delay decision of shunting in those patients to avoid complications attributed to unnecessary procedures. MMC not treated on initial inpatient stay has increased. Aim of the Work Comparing simultaneous Ventriculoperitoneal Shunting versus Delayed shunting in surgical repair of meningiocele in neonates with Chiari Type II regarding outcome, shunt related complications, and analysing the importance of Ventriculo-peritoneal shunting in such cases. Patients and Methods This systematic review From January 1990 to January 2021 through Internet search through MEDLINE, Google Scholar and Cochrane Collaboration Library. The study included all available studies from 1990-2021 including randomized or non-randomized clinical trials, prospective or retrospective observational cohort, and case-control studies that address these criteria was collected. Articles that were excluded that articles not fitting the inclusion and exclusion criteria, duplicated articles, unavailable full texts, or abstract-only articles as preceding papers, conference, editorial, and author response. Results In recent few years, there’s an emerging trend of favoring the simultaneous shunting (ST) over delayed shunting (DT). This may be due to attributed risk carried by increase in the rate of shunt infection (2.79% vs 3.34), moreover shunt revision when both techniques are compared shows the superiority of the simultaneous shunting (3% vs 8%). Conclusion Delayed treatment of hydrocephalus during initial hospitalization resulted in decreasing shunt infection. Compared to NIS study that stated longer inpatient stay associated with DT increased rate of shunt infection and malfunction, in the short period of time.