Postnatal Management and Outcomes of Hydrocephalus in Patients with Myelomeningocele: a Retrospective Study from a Single Institution

Background: This study aims to analyze retrospectively the incidence and management of hydrocephalus in patients with myelomeningocele (MMC) treated at the Gülhane Training and Research Hospital between 2017 and 2022. The study focuses on patients diagnosed with both MMC and hydrocephalus, either prenatally or postnatally. Materials and Methods: We retrospectively reviewed the medical records of 30 patients diagnosed with MMC and hydrocephalus. Variables such as gender, birth weight, localization of the MMC sac, timing of MMC repair surgery, and the onset and management of hydrocephalus were documented. Exclusion criteria included patients operated on alone for either MMC or hydrocephalus, patients with diastematomyelia, myelocele, or lipomyelomeningocele, as well as cases with incomplete records. Results: Of the 30 patients included in the study, 13 (43.3%) were male, and 17 (56.7%) were female. Hydrocephalus was detected at birth in 10 patients (33.3%), while it developed postoperatively in 20 patients (66.7%). MMC lesions were observed in the thoracic region (4 patients, 13.3%); the lumbar region (6 patients, 20%); the sacral region (5 patients, 16.7%); the thoracolumbar region (6 patients, 20%); and the lumbosacral region (9 patients, 30%). Ventriculoperitoneal shunt (VPS) placement was performed in 12 (60%) of the 20 patients who developed hydrocephalus postoperatively; while endoscopic third ventriculostomy (ETV) was performed in 8 patients (40%). Among the 10 patients who presented with hydrocephalus at birth, VPS was performed after initial placement of an Ommaya reservoir. Conclusion: Hydrocephalus remains a significant and challenging complication in MMC patients, often requiring surgical intervention. The timing and approach to the treatment of hydrocephalus, particularly in the context of MMC, demand careful consideration to minimize the risk of infection and surgical complications. Our findings suggest that while ETV combined with VPS can be effective, close monitoring and timely intervention are crucial to managing hydrocephalus in these patients.