An Evaluation of the Effectiveness of Simultaneous Ventriculo-Peritoneal Shunt Placement and the Sequential Shunting- in Neonatal Myelomeningocele

Abstract

A randomized control trail study has been designed and carried out during the period of July 2014 to October 2016 (27 months) in the Department of Paediatric Surgery, Rajshahi Medical College, Rajshahi, Bangladesh. Twenty Six (26) neonates with myelomeningocele were taken as sample volume. This study was under taken to evaluate the effectiveness of simultaneous ventriculo-peritoneal shunt placement and the sequential shunting. These patients were randomly selected for this study and divided in to two groups. Thirteen patients were undergone repair of myelomeningocele with simultaneous insertion of vetriculo-pritoneal shunt and another 13 patients were undergone only myelomeningocele repair, at first stage. Twelve (12) patients were developed hydrocephalus later that subsequently needed ventriculoperitoneal shunt placement on an average after 31 days. Simultaneous surgery had the advantage of exposing the patients to one rather than two operations. Duration of hospital stay has reduced seven days, though operation time has increased 44 minutes that has not affected the outcome. No difference did exist between two groups but those were shunted simultaneously appeared to enjoy clear benefit. There was significant difference of wound complications like wound breakdown and wound infection between two groups, but wound leakage exclusively occured seven patients in sequentially shunted patients. Shunt related complications were remained same in both groups. There was gross deviation of preoperative OFC (+5.15%) in sequentially shunted patients, which was improved after shunt placement (+2.04%). But, there was significant (P<0.001) difference of OFC between two groups on follow up. Ventricular diameter was rapidly increased (42.65 mm) after repair of myelomeningocele in sequential shunted patients that was reduced after shunt placement but remained at least 7 mm larger than the simultaneous shunted patients. This has also affected the expansion of cortical thickness of brain in sequentially shunted patients which was 3mm less than simultaneously shunted patients. This difference significantly (P<0.01) differ the intelligence quotient. Simultaneously shunted patients also enjoying better health (67%) than sequentially shunted (56%) patients. Simultaneous shunting avoided prolong periods of progressive hydrocephalus compared with those sequentially shunted, thereby averting further cerebral injury and improving intelligence and physical growth.