When should ventriculoperitoneal shunt placement be performed in cases with myelomeningocele and hydrocephalus?

The shunt infection rates vary from 2 to 39% among complications related to shunts used for hydrocephalus treatment. Shunt infections are reported to be more common than any other etiologies in newborn babies with myelomeningocele. In this study, we performed a retrospective evaluation of 94 MM and HS cases that were treated in our clinics between 1994 and 2005. Comparisons of shunt infection rates of cases that had surgical placement of VPS either at a different session (group A) or in the same session (Group B) with repair of MM sac were made. Sixty three patients were grouped in group A and 31 cases in group B. MM sac operation site wound infection was seen in 7 versus 5 cases, CSF fistula in 5 versus 3 cases and VPS infection in 9 versus 6 cases in group A and B respectively. 6 patients had meningitis in both groups. These data indicate that ventriculoperitoneal shunt placement in the same session of MM sac repair in patients with HS is not an acceptable practice. We therefore believe in VPS placement in a separate session by confirming absence of infection after MM sac repair surgery.