MANAGEMENT AND OUTCOMES OF MYELOMENINGOCELE ASSOCIATED HYDROCEPHALUS

Main Article Content

Syed Mansoor Shah
Aafaq Ahmad Qarnain Khalil
Dr Fakhar Hayat
Muhammad Assad Javed
Rizwan Khan
Faizuddin
Mian Iftikhar ul Haq

Keywords

.

Abstract

Introduction: Hydrocephalus, which is a clinical phenomenon with poor circulation in cerebrospinal fluids, is often related to myelomeningocele because of the disruptions.


 Objectives: The main objective of the study is to find the management and outcomes of myelomeningocele associated hydrocephalus.


Methodology of the study: This retrospective design study was conducted at Lady Reading Hospital, Peshawar from January 2021 to December 2023. Data were collected from 80 patients suffering from myelomeningocele associated hydrocephalus. Data were extracted from electronic medical records and imaging databases, encompassing demographic information, prenatal history, myelomeningocele characteristics, associated anomalies, initial presentation, diagnostic findings, treatment modalities, perioperative complications, and long-term outcomes. Data were collected through a designed performa.


Results: Data were collected from 80 patients according to inclusion criteria of the study. Mean age was 6 ± 2.5 months and out of 80 patients there were 55 male and 45 female patients. 60% shows lumbar myelomeningocele, 25% thoracic and 15% shows lumbosacral myelomeningocele. 40% patients show the prenatal history of associated anomalies.In our study, the most common treatment modality for myelomeningocele-associated hydrocephalus was ventriculoperitoneal shunt placement (VPS), utilized in 65% of cases. Endoscopic third ventriculostomy (ETV) was employed in 20% of patients, providing an alternative to shunt placement. Shunt revisions were required in 15% of cases, highlighting the challenges associated with long-term shunt management.


Conclusion: It is concluded that the management of myelomeningocele-associated hydrocephalus requires a multidisciplinary approach tailored to individual patient needs. Despite challenges such as perioperative complications, our study demonstrates promising long-term outcomes, emphasizing the efficacy of current treatment strategies.

Abstract 52 | Pdf Downloads 16

References

1. Takoutsing BD, Yanez Touzet A, Park JJ, Lee SH, Bligh ER, Egiz A, Gillespie CS, Figaji A; Neurology and Neurosurgery Interest Group. Management and outcomes of myelomeningocele-associated hydrocephalus in low-income and middle-income countries: a systematic review and meta-analysis protocol. BMJ Open. 2023 Feb 7;13(2):e066339. doi: 10.1136/bmjopen-2022-066339. PMID: 36750288; PMCID: PMC9906258.
2. McCarthy DJ, Sheinberg DL, Luther E, et al.. Myelomeningocele-associated hydrocephalus: nationwide analysis and systematic review. Neurosurg Focus 2019;47:E5. 10.3171/2019.7.FOCUS19469
3. Oumer M, Taye M, Aragie H, et al.. Prevalence of spina bifida among newborns in Africa: a systematic review and meta-analysis. Scientifica (Cairo) 2020;2020:4273510. 10.1155/2020/4273510
4. Ntimbani J, Kelly A, Lekgwara P. Myelomeningocele - A literature review. Interdisciplinary Neurosurgery 2020;19:100502. 10.1016/j.inat.2019.100502
5. Dewan MC, Rattani A, Mekary R, et al.. Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis. J Neurosurg 2018;2018:1–15. 10.3171/2017.10.JNS17439
6. Mnguni MN, Enicker BC, Madiba TE. A perspective in the management of myelomeningocoele in the KwaZulu-Natal Province of South Africa. Childs Nerv Syst 2020;36:1521–7. 10.1007/s00381-020-04506-9
7. Ben-Israel D, Mann JA, Yang MMH, et al.. Clinical outcomes in pediatric hydrocephalus patients treated with endoscopic third ventriculostomy and choroid plexus cauterization: a systematic review and meta-analysis. J NeurosurgPediatr 2022;2022:1–13. 10.3171/2022.3.PEDS21512
8. Pande A, Lamba N, Mammi M, et al.. Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric and adult population: a systematic review and meta-analysis. Neurosurg Rev 2021;44:1227–41. 10.1007/s10143-020-01320-4
9. Sterne JAC, Savović J, Page MJ, et al.. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:l4898. 10.1136/bmj.l4898
10. Shi L, Lin L. The trim-and-fill method for publication bias: practical guidelines and recommendations based on a large database of meta-analyses. Medicine (Baltimore) 2019;98:e15987. 10.1097/MD.0000000000015987
11. Muir RT, Wang S, Warf BC. Global surgery for pediatric hydrocephalus in the developing world: A review of the history, challenges, and future directions. Neurosurgical Focus. 2016;41:1-8. DOI: 10.3171/2016.7.FOCUS16273
12. Takoutsing, B. D., Touzet, A. Y., Park, J. J., Lee, S. H., Bligh, E. R., Egiz, A., ... &Figaji, A. (2023). Management and outcomes of myelomeningocele-associated hydrocephalus in low-income and middle-income countries: a systematic review and meta-analysis protocol. BMJ open, 13(2), e066339.
13. Takoutsing, B. D., Touzet, A. Y., Park, J. J., Lee, S. H., Bligh, E. R., Egiz, A., ... &Figaji, A. (2022). Management and outcomes of myelomeningocele-associated hydrocephalus in low-and middle-income countries: a systematic review and meta-analysis protocol. medRxiv, 2022-06.
14. Fletcher, J. M., Houtrow, A. J., MacPherson, C., Thomas, N. H., Gupta, N., Adzick, N. S., & Thom, E. A. (2023). Hydrocephalus and school-age neurodevelopmental outcomes in the management of myelomeningocele prenatal surgery trial: a secondary analysis. Journal of Neurosurgery: Pediatrics, 31(6), 517-527.
15. Cavalheiro, S., da Costa, M. D. S., Barbosa, M. M., Dastoli, P. A., Mendonça, J. N., Cavalheiro, D., & Moron, A. F. (2021). Hydrocephalus in myelomeningocele. Child's Nervous System, 37(11), 3407-3415.
16. Omar, A. T., Espiritu, A. I., & Spears, J. (2022). Endoscopic third ventriculostomy with or without choroid plexus coagulation for myelomeningocele-associated hydrocephalus: systematic review and meta-analysis. Journal of Neurosurgery: Pediatrics, 29(4), 435-443.
17. Karuparti, S., Dunbar, A., Varagur, K., Sudanagunta, K., Mingo, M., Bligard, K. H., ... &Strahle, J. M. (2024). Predictors and timing of hydrocephalus treatment in patients undergoing prenatal versus postnatal surgery for myelomeningocele. Journal of Neurosurgery: Pediatrics, 1(aop), 1-10.
18. Weaver, K. J., McDowell, M. M., White, M. D., Tempel, Z. J., Zwagerman, N. T., Deibert, C. P., ... & Greene, S. (2021). Comparison of follow-up length-matched single-center myelomeningocele postnatal closure cohort to the Management of Myelomeningocele Study (MOMS) trial results. Pediatric Neurosurgery, 56(3), 229-238.