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Updated: Feb 10, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Timing of ventriculoperitoneal shunt insertion following spina bifida closure in Kenya
Franklin C Margaron1, Dan Poenaru, Richard Bransford
1VCUHS Department of Surgery, P.O. Box 980135, Richmond, VA, USA. fmargaron@mcvh-vcu.edu
Insights
For spina bifida (SB) patients with hydrocephalus in developing countries, delaying ventriculoperitoneal shunting 5-10 days after myelomeningocele closure significantly reduces shunt infection and malfunction rates.
Area of Science:
- Pediatric Neurosurgery
- Developmental Neuroscience
- Clinical Outcomes Research
Background:
- Western medical centers often perform simultaneous myelomeningocele closure and ventriculoperitoneal shunting for spina bifida (SB) with hydrocephalus (HC).
- This approach is challenging in developing countries due to delayed patient presentation with open myelomeningoceles.
- Delayed presentation necessitates evaluating optimal timing for shunting to minimize complications.
Purpose of the Study:
- To assess the impact of shunting timing relative to myelomeningocele closure on shunt-related complications.
- Specifically investigating rates of SB wound infection, shunt infection, and shunt malfunction.
- To provide evidence-based recommendations for managing SB patients in resource-limited settings.
Main Methods:
- Retrospective analysis of 276 spina bifida patients.
- Patients underwent ventriculoperitoneal shunting within 11 days of myelomeningocele closure at Kijabe Hospital (1997-2007).
- Data extracted from hospital records and analyzed using SPSS.
Main Results:
- Shunting within 4 days of SB closure showed a fivefold higher shunt infection rate (23%) compared to 5-10 days post-closure (4.7%).
- Shunt malfunction rates were significantly higher when shunting occurred before (33.3%) or simultaneously (15.4%) with closure versus 5-10 days after (13.9%).
- No significant differences in wound infections or shunt complications were observed between shunting 5-10 days post-closure.
Conclusions:
- In developing countries, for spina bifida patients requiring shunting with sterile CSF, insertion 5-10 days post-myelomeningocele closure is recommended.
- This timing strategy reduces shunt infection and malfunction rates.
- Optimizing shunt placement timing improves outcomes for delayed-presenting SB patients.
Purpose:
In Western medical centers, emphasis has been placed on simultaneous myelomeningocele closure and ventriculoperitoneal shunting for children with spina bifida (SB) and co-morbid hydrocephalus (HC). This is not practical in developing countries where patients present in a delayed fashion, many with open, dirty myelomeningoceles. The purpose of this study was to evaluate whether timing of shunting in relation to myelomeningocele closure affected shunt-related complications such as SB wound infection, shunt infection, and shunt malfunction.
Methods:
A retrospective analysis was undertaken of all SB patients undergoing ventriculoperitoneal shunting within 11 days following myelomeningocele closure at Kijabe Hospital between 1997 and August 2007. Data were collected from hospital records and analyzed in SPSS.
Results:
Over the study period there were 276 patients included. Eighteen patients were shunted prior to SB closure and 13 patients had simultaneous shunting and SB closure. Patients shunted prior to, simultaneously, or within the first 4 days after SB closure had a fivefold higher shunt infection rate (23%) than those shunted 5-10 days following SB closure (4.7%) (p < 0.0001). Shunt malfunctions were also significantly higher in the group shunted prior to back closure (33.3%) vs. those shunted simultaneously (15.4%) or within the first 10 days following SB closure (13.9%) (p = 0.0001). No difference was seen in these groups with regard to wound infections. No difference in shunt-related complications was observed between those shunted 5 to 10 days following back closure.
Conclusions:
This study indicates that in developing countries, patients with SB who present in a delayed fashion but require shunting and have sterile CSF, should have their shunts inserted 5-10 days after SB closure.
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