We sought to determine methods of precise gradation of hydrocephalus in patients with spina bifida. Symptomatic hydrocephalus is a common condition associated with myelomeningocele (open spina bifida). Traditionally, hydrocephalus is treated with insertion of the ventriculo-peritoneal (VP) shunt. This has been the standard of treatment since the introduction of the Holter shunt valve for the VP shunt in the early 1960s.
We have analized the results of surgical treatment of 81 patients aged between 1 month and 1.5 year old with hydrocephalus and MMC. All patients underwent surgery in Republican center of neurosurgery of Uzbekistan for MMC with hydrocephalus in the period of 2013–2018. We suggest to use the ventricular index to determine the precise degree of hydrocephalus in patients with spina bifida and the method for selecting valve parameters.
Patients with suspection of associated hydrocephalus, in order to arresting the risk of MMC rupture and prevention of possible leakage after the back closure a VP shunt was performed. According to above mentioned 52 (64.2%) patients for the 1st stage underwent VP shunt surgery with a low-pressure valve, 23 (28.4%) patients with medium pressure and 6 (7.4%) with high pressure valve. MMC repair was done in 1–3 month after VP shunt placement. To all patients we used regular valve shunts due to high cost of adjustable one and lack of official distributors (health insurance has not yet implemented in our country).
The implantable shunt systems parameters were chosen before surgery in the surgical management of hydrocephalus in children with MMC are essential. This is important in order to prevent under or over drainage states, CSF leakage from the MMC sac. Management of hydrocephalus should be performed by considering MMC affecting craniospinal balance.
The 3 main signs of spina bifida – hydrocephalus, paraplegia and dysfunction of the pelvic organs by the type of incontinence have been known for many centuries, although these signs were not associated with myelomeningocele (MMC) until the 17th century , , .
The first researcher who came close to the understanding of connection between myelomeningocele and hydrocephalus was Frederick Ruysch (1638–1731), but only the Italian pathologist Giovanni Battista Morgagni (1672–1771) clearly described this relationship and that myelomeningocele can be accompanied both with hydrocephalus and without it , , , , .
Gardner advanced the theory that overgrowth of the neural tube could be the cause of hydrocephalomyelia, but this interesting theory found rebuttal in modern neuroimaging and embryology .
Hydrocephalus basically accompanies open forms of spina bifida – myelomeningocele. Before the introduction of cerebrospinal fluid (CSF) shunting surgery in the early 1960s, hydrocephalus was the leading cause of death and disability in patients with myelomeningocele , , , , , , , .
The true frequency of hydrocephalus in patients with myelomeningocele is not known, although in the main multicenter studies the need for shunting procedures reaches the value 80–90% , , , , , , .