Abstract
Hydrocephalus (HC) is a major problem for the majority of patients with myelomeningocele (MM). Historically, the correlation of MM with HC was suspected as early as 1769 by Morgagni [1], who hypothesized that an excess of fluid caused both the spinal cyst and the hydrocephalus. He was, however, unable to explain the relationship in more detail, and his theory had to await a better understanding of the circulation of cerebrospinal fluid (CSF) in the twentieth century, with the works of Dandy and Blackfan, to gain approval [2]. Gardner imagined that overdistension of the fetal neural tube caused hydrocephalomyelia and explained all dysraphic states (which in his mind included the Chiari I malformation), but this interesting theory has not been upheld in face of the evidence gained from modern imaging and embryology [3]. The pathophysiology of MM-related HC (MMH) is still a matter of debate, with important therapeutic implications; in particular the role of prenatal meningeal irritation caused by the amniotic fluid, and the putative effect of in utero surgery [4].
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Russell Dorothy S (1935) The mechanism of internal hydrocephalus in spina bifida. Brain 58:203–215
Dandy WE, Blackfan KD (1914) Internal hydrocephalus: an experimental, clinical and pathological study. Am J Dis Child 8:406–482
Gardner WJ (1965) Hydrodynamic mechanism of syringomyelia: its relationship to myelocele. J Neurol Neurosurg Psychiatr 28:247–259
Tulipan N, Sutton LN, Bruner JP et al (2003) The effect of intrauterine myelomeningocele repair on the incidence of shunt-dependent hydrocephalus. Pediatr Neurosurg 38:27–33
Rekate HL (1988) Management of hydrocephalus and the erroneous concept of shunt independence in spina bifida patients. BNI Quarterly 4:17–20
Dirks PB, Drake JM, Lamberti-Pasculli M et al (2005) Falling ventriculo-peritoneal shunt rates in myelo — menin gocele (abstr). Childs Nerv Syst 19:607
Crimmins D, Hayward RD, Thompson DNP (2005) Reducing shunt placement rate in myelomeningocele patients (abstr). Childs Nerv Syst 21:828–829
De la Cruz R, Millan JM, Miralles M, Munoz MJ (1989) Cranial sonographic evaluation in children with myelomeningocele. Childs Nerv Syst 5:94–98
Bowman RM, McLone DG, Grant JA et al (2001) Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg 34:114–120
Alatise OI, Adeolu AA, Komolafe EO et al (2006) Patterns and factors affecting management of spina bifida cystica in Ile-Ife, Nigeria. Pediatr Neurosurg 42:277–283
Rintoul N, Sutton LN, Hubbard AM et al (2002) A new look at myelomeningoceles: functional level, vertebral level, shunting, and the implications for fetal intervention. Pediatrics 109:409–413
Dias MS, McLone DG (1994) Spinal dysraphism. In: Weinstein SL (ed) The pediatric spine, vol 1. Raven, New York, pp 343–368
Aubry MC, Aubry JP, Dommergues M (2003) Sonographic prenatal diagnosis of central nervous system abnormalities. Childs Nerv Syst 19:391–402
Oi S, Honda Y, Hidaka M et al (1998) Intrauterine highresolution magnetic resonance imaging in fetal hydrocephalus and prenatal estimation of postnatal outcomes with “perspective classification”. J Neurosurg 88:685–694
Kazmi SS, Nejat F, Tajik P, Roozbeh H (2006) The prenatal ultrasonographic detection of myelomeningocele in patients referred to Children’s Hospital Medical Center: a cross-sectional study. Reprod Health 3:6 doi:10.1186/1742-4755-3-6
Oi S (2003) Current status of prenatal management of fetal spina bifida in the world: worldwide cooperative survey on the medico-ethical issue. Childs Nerv Syst 19:596–599
Raybaud C, Levrier O, Brunel H et al (2003) MR imaging of fetal brain malformations. Childs Nerv Syst 19:455–450
Sgouros S (2004) Hydrocephalus with myelomeningocele. In: Cinalli G, Sainte-Rose C, Maixner W (eds) Pediatric hydrocephalus. Springer, Milan, pp 133–144
Teo C, Jones R (1996) Management of hydrocephalus by endoscopic third ventriculostomy in patients with myelomeningocele. Pediatr Neurosurg 25:57–63
Vinchon M, Dhellemmes P (2006) Cerebrospinal shunt infection: risk factors and long term follow-up. Childs Nerv Syst 22:692–677
Solan K, Glaisyer H (2006) Raised intracranial pressure in a neonate presenting as stridor. Pediatr Anesth 16:877–879
Hall P, Lindseth R, Campbell R et al (1979) Scoliosis and hydrocephalus in myelocele patients; the effects of shunting. J Neurosurg 50:174–178
Natelson SE (1981) Early third ventriculostomy in myelomeningocele infants — shunt independence? Childs Brain 8:321–325
Nadkarni TD, Rekate HL (2005) Treatment of refractory intracranial hypertension in a spina bifida patient by a concurrent ventricular and cisterna magna-to-peritoneal shunt. Childs Nerv Syst 21:579–582
Shurtleff DB, Kronmal R, Foltz EL (1975) Follow-up comparison of hydrocephalus with and without myelomeningocele. J Neurosurg 42:61–68
Iborra J, Pages E, Cuxart A et al (2000) Increased intracranial pressure in myelomeningocele (MMC) patients never shunted: results of a prospective preliminary study. Spinal Cord 38:495–497
Epstein NE, Rosenthal AD, Zito J, Osipoff M (1985) Shunt placement and myelomeningocele repair: simultaneous vs. sequential shunting. Childs Nerv Syst 1:145–147
Hubballah MY, Hoffmann HJ (1987) Early repair of myelomeningocele and simultaneous insertion of ventriculoperitoneal shunt: technique and results. Neurosurgery 20:21–23
McLone DG (1998) Care of the neonate with a myelo — meningocele. Neurosurg Clin North Am 9:111–120
Caldarelli M, Di Rocco C, La Marca F (1996) Shunt complications in the first postoperative year in children with meningomyelocele. Childs Nerv Syst 12:748–754
Rolle U, Gräffe G (1999) About the rate of shunt complications in patients with hydrocephalus and myelomeningocele. Eur J Pediatr Surg 9(suppl I): 51–52
Gamache FW (1995) Treatment of hydrocephalus in patients with meningomyelocele or encephalocele: a recent series. Childs Nerv Syst 11:487–488
Mazza C, Pasqualin A, Da Pian R (1980) Results of treatment with ventriculoatrial and ventriculoperitoneal shunt in infantile non tumoral hydrocephalus. Childs Brain 7:1–14
Byard RW (1996) Mechanisms of sudden death and autopsy findings in patients with Arnold-Chiari malformation and ventriculoatrial catheters. Am J Forensic Med Pathol 17:260–263
Tuli S, Tuli J, Drake J, Spears J (2004) Predictors of death in pediatric patients requiring cerebrospinal fluid shunts. J Neurosurg (Pediatr) 100(suppl 5):442–446
Steinbok P, Irvine B, Cochrane DD, Irwin BJ (1992) Long-term outcome and complications of children with myelomeningocele. Childs Nerv Syst 8:92–96
Vinchon M, Dhellemmes P (2007) The transition from child to adult in neurosurgery. Adv Techn Standarts Neurosurg 32:3–24
Liptak GS, Bolander HM, Langworthy K (2001) Screening for ventricular shunt function in children with hydrocephalus secondary to myelomeningocele. Pediatr Neurosurg 34:281–285
Tubbs RS, Wellons JC, Blount JP, Oakes J (2005) Transient ventriculoperitoneal shunt dysfunction in children with myelodysplasia and urinary bladder infection. J Neurosurg (Pediatr) 102(suppl 2):221–223
Mirzai H, Ersahin Y, Mutluer S, Kayahan A (1998) Outcome of patients with myelomeningocele. Childs Nerv Syst 14:120–123
Vinchon M, Baroncini M, Thines L, Dhellemmes P (2006) Bowel perforation by peritoneal shunt catheters: diagnosis and treatment. Neurosurgery 58(1 suppl ONS):76–82
Iskandar BJ, Tubbs S, Mapstone TB et al (1998) Death in shunted hydrocephalic children in the 1990s. Pediatr Neurosurg 28:173–176
Tomlinson P, Sugarman ID (1995) Complications with shunts in adults with spina bifida. Brit Med J 311:286–287
Davis BE, Daley CM, Shurtleff DB et al (2005) Longterm survival of individuals with myelomeningocele. Pediatr Neurosurg 41:186–191
Hunt GM, Oakeshot P, Kerry S (1999) Link between the CSF shunt and achievement in adults with spina bifida. J Neurol Neurosurg Psychiatr 67:591–595
McLone DG, Czyzewski D, Raimondi AJ, Sommers RC (1982) Central nervous system infection as a limiting factor in the intelligence of children with myelo meningocele. Pediatrics 70:338–342
Hetherington R, Dennis M, Barnes M et al (2006) Functional outcome in young adults with spina bifida and hydrocephalus. Childs Nerv Syst 22:117–124
Lorber J, Pucholt V (1981) When is a shunt no longer necessary? Z Kinderchir 34:327–329
Vinchon M, Fichten A, Delestret I, Dhellemmes P (2003) Revision for asymptomatic shunt failure: surgical and clinical results. Neurosurgery 52:347–356
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2008 Springer-Verlag Italia
About this chapter
Cite this chapter
Vinchon, M., Dhellemmes, P. (2008). Hydrocephalus in Myelomeningocele: Shunts and Problems with Shunts. In: The Spina Bifida. Springer, Milano. https://doi.org/10.1007/978-88-470-0651-5_17
Download citation
DOI: https://doi.org/10.1007/978-88-470-0651-5_17
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-0650-8
Online ISBN: 978-88-470-0651-5
eBook Packages: MedicineMedicine (R0)