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An Evaluation of the Effectiveness of Simultaneous Ventriculo-Peritoneal Shunt Placement and the Sequential Shunting- in Neonatal Myelomeningocele

Received: 5 February 2020     Accepted: 10 June 2020     Published: 4 August 2020
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Abstract

A randomized control trail study has been designed and carried out during the period of July 2014 to October 2016 (27 months) in the Department of Paediatric Surgery, Rajshahi Medical College, Rajshahi, Bangladesh. Twenty Six (26) neonates with myelomeningocele were taken as sample volume. This study was under taken to evaluate the effectiveness of simultaneous ventriculo-peritoneal shunt placement and the sequential shunting. These patients were randomly selected for this study and divided in to two groups. Thirteen patients were undergone repair of myelomeningocele with simultaneous insertion of vetriculo-pritoneal shunt and another 13 patients were undergone only myelomeningocele repair, at first stage. Twelve (12) patients were developed hydrocephalus later that subsequently needed ventriculoperitoneal shunt placement on an average after 31 days. Simultaneous surgery had the advantage of exposing the patients to one rather than two operations. Duration of hospital stay has reduced seven days, though operation time has increased 44 minutes that has not affected the outcome. No difference did exist between two groups but those were shunted simultaneously appeared to enjoy clear benefit. There was significant difference of wound complications like wound breakdown and wound infection between two groups, but wound leakage exclusively occured seven patients in sequentially shunted patients. Shunt related complications were remained same in both groups. There was gross deviation of preoperative OFC (+5.15%) in sequentially shunted patients, which was improved after shunt placement (+2.04%). But, there was significant (P<0.001) difference of OFC between two groups on follow up. Ventricular diameter was rapidly increased (42.65 mm) after repair of myelomeningocele in sequential shunted patients that was reduced after shunt placement but remained at least 7 mm larger than the simultaneous shunted patients. This has also affected the expansion of cortical thickness of brain in sequentially shunted patients which was 3mm less than simultaneously shunted patients. This difference significantly (P<0.01) differ the intelligence quotient. Simultaneously shunted patients also enjoying better health (67%) than sequentially shunted (56%) patients. Simultaneous shunting avoided prolong periods of progressive hydrocephalus compared with those sequentially shunted, thereby averting further cerebral injury and improving intelligence and physical growth.

Published in International Journal of Clinical and Experimental Medical Sciences (Volume 6, Issue 4)
DOI 10.11648/j.ijcems.20200604.13
Page(s) 65-70
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Comparison, Simultaneous V-P Shunting, Sequential V-P Shunting

References
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[2] Warwick, JP, 1998, ‘Management of spina bifida, Hydrocephalus, central nervous system infections and intractable epilepsy’, in Paediatric surgery, 5th edn, O’Neill, Row, Grosfield, Mosby-year book, Missuri, 21, pp. 1849-1853.
[3] Reigel, DH, & Rotenstein, D 1994, ‘Spina bifida’ in Pediatric Neurosurgery, 3rd edn, Check, WR, Marlin, AE, McLone, DG, Warker, MZ, WB sanders company, Philadlphia, London, 3, pp. 51-53.
[4] Lorber, J & Salfield, S 1981, ‘Result of selective treatment of spina bifida cystica’, Arch Dis Child, 56, pp. 822-826.
[5] Leek, I, 1984 ‘The geographic distribution of neural tube deffect and oral cleft’, Br. Med. Bull, 40, pp. 390-395.
[6] Leek, I 1972, ' The aetiology of human malformation and insights from epidemiology’, teratology, 5, pp. 300-303.
[7] Carter, CO 1975, 'Clues to the aetiology of Neural tube malformation’, Develop Med s Child Neurol, 16 (32), pp. 3-15.
[8] Milunsky, A, Uleickas, M, Rothman, J 1992, ‘Maternal heat exposer and neural tube defects’, Journal of American Medical Association, 268, pp. 882-885.
[9] Oakeshott, P & Hunt, GM 1989, ‘valproate and spina bifida’, British Medical Journal, 298, pp. 1300-1301.
[10] Mulenare, J, Cordero, JF, Erickson, JD, Berry, RJ 1988, ‘Periconceptional use of multivitamins and the occurrence of neural tube defects’, Journal of American Medical Association, 260, pp. 3141-3145.
[11] Lorber, J & Ward, AM 1985, ‘Spina bifida-A vanishing nightmare?’ Arch Dis, Child, 60, pp. 1086-1091.
[12] Mouric, MC, Conner, JM, Ferguson Smith, MA 1990, ‘Patient care befoe and after termination of pregnancy for neural tube deffects’, Prenatal Diag, 10 (8), pp. 497-505.
[13] Neven, P, Ricketts, NEM, Gerisson, RT, Smith, R, Crawford, JW 1991, ‘Screning for neural tube defect with maternal serum alpha feto protein and ultrasound without the use of amniocentesis’, Journal of obstetics and Gynaecology, 11, pp. 5-8.
[14] Puri, P and Sharma, R 2003, ‘Spina bifida and Encephalocele’, in Newborn surgery, 2nd edn, Prempuri, Arnold, London, 82, pp. 761-765.
[15] McLone, DG & Naidich, TP, 1995, ‘The investigation of hydrocephalus by computed tomography’, Clin Neurosurg, 32, pp. 527-529.
[16] Steinbok, P, Brendon Irvin, D. Douglus Cochrane and Beverly, J, Irwin 1992, ‘Long term outcome and complication of children born with myelomeningocele’, Child’s Nerv Syst, 8, pp. 92-96.
[17] Hubballah, MY & Hoffman, HJ 1987, ‘Early repair of myelomeningocrlr and simultaneous insertion of VP shunt: Trchnique and Result’, J Neurosurgery, 20, pp. 21-23.
[18] Russell, RCG, Williams, NS, Bulstrode, CJK (eds) 2004, ‘Elective Neurosurgery’, in Baily & Love’s Short Practice of Surgery, 24th edn, Arnold, London, ISE in Oxford University Press Inc, New york, 44, pp. 606-615.
[19] Epstein, NE, Rosenthal, AD, Joshep, Z, Osipoff, M 1985, ‘Shunt placement and myelomeningocele repair: simultaneous VS sequential shunting, Review of 12 cases’, Child’s Nerv Syst, 1, pp. 145-147.
[20] Hoffman, HJ, 1997, ‘Myelomeningocele, Curent therapy in Neurological surgery’, concept paediatric Neuro Surg, 12, pp. 217-223.
[21] McLone, DG & Naidich, TP 1989, ‘Myelomeningocele: Outcome and late complication, In Paediatric Neurosurgery, 2nd edn, Mc Lanria, RL, Schent, L, Venes, JL, Philadelphia, WB Saunders, 12, pp. 53-70.
[22] Harold, LR 1984, ‘To shunt or not to shunt: Hydrocephalus and Dysraphism’, Concept of Pediatric Neurosurg, 29, pp 593-607.
[23] Timothy, BM, Harold, LR, Nulsen, FE, Dixon, MS, Glaser, N, Miriam, J 1984, ‘Relationship of CSF shunting and IQ in children with myelomeningocele: A retrospective analysis’ Child Brain, 11, pp. 112-118.
Cite This Article
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    Md. Nowshad Ali, Mst. Rokeya Khatun, Shah Md. Ahsan Shahid, Md. Kamruzzaman. (2020). An Evaluation of the Effectiveness of Simultaneous Ventriculo-Peritoneal Shunt Placement and the Sequential Shunting- in Neonatal Myelomeningocele. International Journal of Clinical and Experimental Medical Sciences, 6(4), 65-70. https://doi.org/10.11648/j.ijcems.20200604.13

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    ACS Style

    Md. Nowshad Ali; Mst. Rokeya Khatun; Shah Md. Ahsan Shahid; Md. Kamruzzaman. An Evaluation of the Effectiveness of Simultaneous Ventriculo-Peritoneal Shunt Placement and the Sequential Shunting- in Neonatal Myelomeningocele. Int. J. Clin. Exp. Med. Sci. 2020, 6(4), 65-70. doi: 10.11648/j.ijcems.20200604.13

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    AMA Style

    Md. Nowshad Ali, Mst. Rokeya Khatun, Shah Md. Ahsan Shahid, Md. Kamruzzaman. An Evaluation of the Effectiveness of Simultaneous Ventriculo-Peritoneal Shunt Placement and the Sequential Shunting- in Neonatal Myelomeningocele. Int J Clin Exp Med Sci. 2020;6(4):65-70. doi: 10.11648/j.ijcems.20200604.13

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  • @article{10.11648/j.ijcems.20200604.13,
      author = {Md. Nowshad Ali and Mst. Rokeya Khatun and Shah Md. Ahsan Shahid and Md. Kamruzzaman},
      title = {An Evaluation of the Effectiveness of Simultaneous Ventriculo-Peritoneal Shunt Placement and the Sequential Shunting- in Neonatal Myelomeningocele},
      journal = {International Journal of Clinical and Experimental Medical Sciences},
      volume = {6},
      number = {4},
      pages = {65-70},
      doi = {10.11648/j.ijcems.20200604.13},
      url = {https://doi.org/10.11648/j.ijcems.20200604.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20200604.13},
      abstract = {A randomized control trail study has been designed and carried out during the period of July 2014 to October 2016 (27 months) in the Department of Paediatric Surgery, Rajshahi Medical College, Rajshahi, Bangladesh. Twenty Six (26) neonates with myelomeningocele were taken as sample volume. This study was under taken to evaluate the effectiveness of simultaneous ventriculo-peritoneal shunt placement and the sequential shunting. These patients were randomly selected for this study and divided in to two groups. Thirteen patients were undergone repair of myelomeningocele with simultaneous insertion of vetriculo-pritoneal shunt and another 13 patients were undergone only myelomeningocele repair, at first stage. Twelve (12) patients were developed hydrocephalus later that subsequently needed ventriculoperitoneal shunt placement on an average after 31 days. Simultaneous surgery had the advantage of exposing the patients to one rather than two operations. Duration of hospital stay has reduced seven days, though operation time has increased 44 minutes that has not affected the outcome. No difference did exist between two groups but those were shunted simultaneously appeared to enjoy clear benefit. There was significant difference of wound complications like wound breakdown and wound infection between two groups, but wound leakage exclusively occured seven patients in sequentially shunted patients. Shunt related complications were remained same in both groups. There was gross deviation of preoperative OFC (+5.15%) in sequentially shunted patients, which was improved after shunt placement (+2.04%). But, there was significant (P<0.001) difference of OFC between two groups on follow up. Ventricular diameter was rapidly increased (42.65 mm) after repair of myelomeningocele in sequential shunted patients that was reduced after shunt placement but remained at least 7 mm larger than the simultaneous shunted patients. This has also affected the expansion of cortical thickness of brain in sequentially shunted patients which was 3mm less than simultaneously shunted patients. This difference significantly (P<0.01) differ the intelligence quotient. Simultaneously shunted patients also enjoying better health (67%) than sequentially shunted (56%) patients. Simultaneous shunting avoided prolong periods of progressive hydrocephalus compared with those sequentially shunted, thereby averting further cerebral injury and improving intelligence and physical growth.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - An Evaluation of the Effectiveness of Simultaneous Ventriculo-Peritoneal Shunt Placement and the Sequential Shunting- in Neonatal Myelomeningocele
    AU  - Md. Nowshad Ali
    AU  - Mst. Rokeya Khatun
    AU  - Shah Md. Ahsan Shahid
    AU  - Md. Kamruzzaman
    Y1  - 2020/08/04
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ijcems.20200604.13
    DO  - 10.11648/j.ijcems.20200604.13
    T2  - International Journal of Clinical and Experimental Medical Sciences
    JF  - International Journal of Clinical and Experimental Medical Sciences
    JO  - International Journal of Clinical and Experimental Medical Sciences
    SP  - 65
    EP  - 70
    PB  - Science Publishing Group
    SN  - 2469-8032
    UR  - https://doi.org/10.11648/j.ijcems.20200604.13
    AB  - A randomized control trail study has been designed and carried out during the period of July 2014 to October 2016 (27 months) in the Department of Paediatric Surgery, Rajshahi Medical College, Rajshahi, Bangladesh. Twenty Six (26) neonates with myelomeningocele were taken as sample volume. This study was under taken to evaluate the effectiveness of simultaneous ventriculo-peritoneal shunt placement and the sequential shunting. These patients were randomly selected for this study and divided in to two groups. Thirteen patients were undergone repair of myelomeningocele with simultaneous insertion of vetriculo-pritoneal shunt and another 13 patients were undergone only myelomeningocele repair, at first stage. Twelve (12) patients were developed hydrocephalus later that subsequently needed ventriculoperitoneal shunt placement on an average after 31 days. Simultaneous surgery had the advantage of exposing the patients to one rather than two operations. Duration of hospital stay has reduced seven days, though operation time has increased 44 minutes that has not affected the outcome. No difference did exist between two groups but those were shunted simultaneously appeared to enjoy clear benefit. There was significant difference of wound complications like wound breakdown and wound infection between two groups, but wound leakage exclusively occured seven patients in sequentially shunted patients. Shunt related complications were remained same in both groups. There was gross deviation of preoperative OFC (+5.15%) in sequentially shunted patients, which was improved after shunt placement (+2.04%). But, there was significant (P<0.001) difference of OFC between two groups on follow up. Ventricular diameter was rapidly increased (42.65 mm) after repair of myelomeningocele in sequential shunted patients that was reduced after shunt placement but remained at least 7 mm larger than the simultaneous shunted patients. This has also affected the expansion of cortical thickness of brain in sequentially shunted patients which was 3mm less than simultaneously shunted patients. This difference significantly (P<0.01) differ the intelligence quotient. Simultaneously shunted patients also enjoying better health (67%) than sequentially shunted (56%) patients. Simultaneous shunting avoided prolong periods of progressive hydrocephalus compared with those sequentially shunted, thereby averting further cerebral injury and improving intelligence and physical growth.
    VL  - 6
    IS  - 4
    ER  - 

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Author Information
  • Department of Paediatric Surgery, Rajshahi Medical College, Rajshahi, Bangladesh

  • Department of Gynaecology and Obstetrics, Rajshahi Medical College, Rajshahi, Bangladesh

  • Department of Paediatric Surgery, Rajshahi Medical College, Rajshahi, Bangladesh

  • Department of Surgery, 250 Bed District Sadar Hospital, Feni, Bangladesh

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