Increased intracranial pressure in myelomeningocele (MMC) patients never shunted: results of a prospective preliminary study.

Abstract

In some young adults non-shunted myelomeningocele (MMC) patients without symptoms or with unspecific clinical findings, moderate or severe stabilised ventriculomegaly are observed in control CT scans. Physicians are then faced with the so-called 'Arrested Hydrocephalus' (AH) syndrome. The present study is part of a prospective protocol in which patients with hydrocephalus associated with MMC and long-term clinical diagnosis of AH were included. To evaluate myelomeningocele patients never shunted with clinical and/or CT scan criteria compatible with AH. Multidisciplinary Spina Bifida Unit in a tertiary university hospital in Barcelona, Spain. Fourteen MMC patients were selected, in all of them, continuous intracranial pressure (ICP) monitoring was performed. Analysis of the ICP records was done using the method described by Borgesen in mmHg. All patients were also studied by intelligence quotient (IQ) testing before and after shunting. The CT in all the study cases showed an Evans ratio </=0.30. The majority of patients (11/14) presented continuous high or intermittently raised ICP (active or unstable compensated hydrocephalus group) and in three (3/14) cases we confirmed the diagnosis of arrested hydrocephalus. There were no complications associated with ICP monitoring. In view of our results, we believe that in all non-shunted cases with clinical and/or CT scan criteria compatible with AH, the use of an objective method, such as continuous ICP monitoring, is necessary to diagnose arrested hydrocephalus, and a more comprehensive method that includes extensive neuropsychological valoration should be developed for the diagnosis and treatment of arrested hydrocephalus. Supported in part by Grant number 97-0923 from the Fondo de Investigaciones Sanitarias de la Seguridad Social (FISS).