Related Experiment Video
Updated: Jun 26, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
When should ventriculoperitoneal shunt placement be performed in cases with myelomeningocele and hydrocephalus?
Ibrahim Suat Oktem1, Ahmet Menkü, Abdurrahman Ozdemir
1Erciyes University Medical Faculty, Neurosurgery, Kayseri, Turkey. oktemis@erciyes.edu.tr
Aim:
The shunt infection rates vary from 2 to 39% among complications related to shunts used for hydrocephalus treatment. Shunt infections are reported to be more common than any other etiologies in newborn babies with myelomeningocele.
Material And Methods:
In this study, we performed a retrospective evaluation of 94 MM and HS cases that were treated in our clinics between 1994 and 2005. Comparisons of shunt infection rates of cases that had surgical placement of VPS either at a different session (group A) or in the same session (Group B) with repair of MM sac were made.
Results:
Sixty three patients were grouped in group A and 31 cases in group B. MM sac operation site wound infection was seen in 7 versus 5 cases, CSF fistula in 5 versus 3 cases and VPS infection in 9 versus 6 cases in group A and B respectively. 6 patients had meningitis in both groups.
Conclusion:
These data indicate that ventriculoperitoneal shunt placement in the same session of MM sac repair in patients with HS is not an acceptable practice. We therefore believe in VPS placement in a separate session by confirming absence of infection after MM sac repair surgery.
Insights
Placing ventriculoperitoneal shunts (VPS) during the same session as myelomeningocele (MM) sac repair increases infection risks. Separate VPS placement after MM repair is recommended to ensure patient safety and reduce complications.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Infectious Disease
Background:
- Shunt infections are a significant complication in hydrocephalus treatment, with rates ranging from 2-39%.
- Infections associated with shunts are particularly prevalent in newborns with myelomeningocele (MM).
Purpose of the Study:
- To evaluate the impact of simultaneous versus staged surgical procedures on shunt infection rates in patients with myelomeningocele and hydrocephalus (HS).
- To determine the optimal timing for ventriculoperitoneal shunt (VPS) placement relative to MM sac repair.
Main Methods:
- A retrospective analysis of 94 patients with MM and HS treated between 1994 and 2005.
- Comparison of shunt infection rates between two groups: Group A (staged VPS placement) and Group B (simultaneous VPS placement with MM sac repair).
Main Results:
- Group A (staged) had lower rates of wound infection (7 vs 5), CSF fistula (5 vs 3), and VPS infection (9 vs 6) compared to Group B (simultaneous).
- Meningitis occurred in 6 patients across both groups, indicating a general risk regardless of surgical timing.
Conclusions:
- Simultaneous placement of ventriculoperitoneal shunts during MM sac repair is associated with increased infection risks and is not recommended.
- VPS placement should be performed in a separate surgical session following MM sac repair, after confirming the absence of infection.
