Intrathecal CSF dynamic measurements in hydrocephalus associated with MMC – Experience of the Republican center of neurosurgery of Uzbekistan

Abstract

PurposeWe sought to determine methods of precise gradation of hydrocephalus in patients with spina bifida. Symptomatic hydrocephalus is a common condition associated with myelomeningocele (open spina bifida). Traditionally, hydrocephalus is treated with insertion of the ventriculo-peritoneal (VP) shunt. This has been the standard of treatment since the introduction of the Holter shunt valve for the VP shunt in the early 1960s. MethodsWe have analized the results of surgical treatment of 81 patients aged between 1 month and 1.5 year old with hydrocephalus and MMC. All patients underwent surgery in Republican center of neurosurgery of Uzbekistan for MMC with hydrocephalus in the period of 2013–2018. We suggest to use the ventricular index to determine the precise degree of hydrocephalus in patients with spina bifida and the method for selecting valve parameters. ResultsPatients with suspection of associated hydrocephalus, in order to arresting the risk of MMC rupture and prevention of possible leakage after the back closure a VP shunt was performed. According to above mentioned 52 (64.2%) patients for the 1st stage underwent VP shunt surgery with a low-pressure valve, 23 (28.4%) patients with medium pressure and 6 (7.4%) with high pressure valve. MMC repair was done in 1–3 month after VP shunt placement. To all patients we used regular valve shunts due to high cost of adjustable one and lack of official distributors (health insurance has not yet implemented in our country). ConclusionThe implantable shunt systems parameters were chosen before surgery in the surgical management of hydrocephalus in children with MMC are essential. This is important in order to prevent under or over drainage states, CSF leakage from the MMC sac. Management of hydrocephalus should be performed by considering MMC affecting craniospinal balance.