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From birth to beyond: predicting incidence and timing of CSF diversion in postnatal MMC closure

Katherine Daniels1, Kelsi M Chesney2, Brannan E O'Neill3

  • 1Princeton University, Princeton, NJ, USA.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|January 30, 2026
PubMed

Insights

Myelomeningocele (MMC) patients often develop hydrocephalus requiring shunts. Elevated frontal-occipital horn ratio (FOHR) and hydrocephalus (HCP) at birth predict shunt need and timing in MMC patients.

Area of Science:

  • Pediatric Neurosurgery
  • Spina Bifida Research
  • Hydrocephalus Management

Background:

  • Myelomeningocele (MMC) is associated with a high incidence of shunt-dependent hydrocephalus.
  • Ventriculoperitoneal shunts (VPS) are frequently required but increase lifetime morbidity for individuals with MMC.

Purpose of the Study:

  • To identify risk factors for VPS placement in MMC patients.
  • To determine the incidence and timing of VPS insertion.
  • To improve outcomes and inform family counseling regarding hydrocephalus in MMC.

Main Methods:

  • Retrospective review of 125 patients undergoing postnatal MMC closure (1998-2022).
  • Analysis of VPS placement, age at insertion, and comparison between shunted and shunt-free cohorts.
  • Utilized Mann-Whitney U, Welch's t-test, Fisher's exact test, and Youden's index to identify predictive factors and optimal thresholds for hydrocephalus (HCP) and frontal-occipital horn ratio (FOHR).

Main Results:

  • 69% of MMC patients required VPS, with 94% placed within 2 months of birth.
  • Higher FOHR and HCP at birth predicted VPS placement.
  • FOHR was a significant predictor of earlier VPS insertion (optimal threshold >0.48).

Conclusions:

  • Elevated FOHR and HCP at birth are predictive of shunt-dependent hydrocephalus in MMC patients.
  • Specific thresholds (FOHR >0.48, HCP >50%) can aid in early identification and management.
  • These findings support improved family counseling and timely intervention for hydrocephalus in MMC.
Abstract

Keywords:
HydrocephalusMyelomeningoceleSpinal dysraphismVentriculoperitoneal shunt

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