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Myelomeningocele Level Affects Shunting In Spina Bifida Patients

Infants with spina bifida are more likely to require a shunt for hydrocephalus when the myelomeningocele (MMC) is located high on the spine.

Incidence of shunting for hydrocephalus also varies according to the specific definition used to assign level, researchers in the United States say.

"Our review of a large single-centre population of MMC patients has demonstrated some disparity between the radiologic and functional assessment of these lesions. In addition, the incidence of shunting for hydrocephalus was found to vary according to the level of the MMC and specific definition (functional versus radiologic) used to assign level.

"These findings are important not only for counselling individual patients but also for the design of foetal intervention trials," say investigators from the Children's Hospital of Philadelphia in Pennsylvania.

They say their findings are in keeping with previous reports that suggested 80 to 85 percent of MMC patients undergoing surgical repair after birth develop hydrocephalus and require a ventricular shunt. Rate of shunting as a function of spinal level was not well established before their study, they note.

The researchers did a retrospective chart review of 297 patients born with open MMCs and followed in the spina bifida clinic at the hospital.

"Overall rate of ventricular shunting was 81 percent," they report. "Level of the lesion significantly affected the incidence of shunting, with more cephalad lesions correlating with higher rates. This was true both for functional and radiologic categorisations.
"A significantly higher shunt rate was found among patients with sacral lesions when categorised by radiologic rather than functional criteria. In 86 percent of patients, the functional level was found to be equal to or higher (worse) than the radiologic level."

There was a significantly lower shunt rate for patients with better functional levels, the researchers point out. "We found that the functional level was equal to the vertebral level in 39 percent of the patients. In nearly half, the functional level was two levels above (worse than) the vertebral level.

"This finding might be explained by inferior displacement of the spinal cord segments in relation to the vertebral segments as a result of congenital tethering.

"Furthermore, we found no difference between the patients delivered by caesarean section and vaginal birth."
Pediatrics, 2002; 109: 409-413.

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