الفهرس 
Title : Clinical and Radiological Predictors of Ventriculo-Peritoneal Shunt Insertion in Myelomeningocele Patients
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Abstract
Background: Myelomeningocele repair conventionally occurs in the post-natal period. With the technological advances in surgical practice and fetal surgeries, intra uterine myelomeningocele repair IUMR is adopted in some centers (Tulipan et al. 2003). Cerebrospinal fluid shunting has numerous complications, most notably shunt failure and shunt infection. Studies have suggested that patients with greater numbers of shunt revisions have poorer performance on neuropsychological testing (Dennis et al. 2007). There is also good evidence to suggest that the IQs of patients with myelomeningocele who do not undergo shunt placement is higher than that of their shunt treated counterparts (Mapstone TB et al. 1986). objective: In this study, we are trying to identify strong clinical and radiological predictors for the need of VP shunt insertion in patients with myelomeningocele who underwent surgical repair and closure of the defect initially.This will decrease the overall rate of shunt placement in this group of patients through applying a strict policy adopting only shunt insertion for the really needing patient. methods: prospective clinical study conducted on 96 patients with myelomeningoceles presented to Aboul Reish Pediatric Specialized Hospital, Cairo University. After confirming the diagnosis via clinical and radiological aid, patients are carefully examined, if hydrocephalus is evident clinically and radiologically a shunt is inserted together with MMC repair at the same session after excluding sepsis or CSF infection. (group A). If there are no signs of increased intracranial pressure, MMC repair shall be done alone (group B). Those patients shall be monitored carefully post-operatively and after discharge and shall be followed up regularly to early detect and promptly manage latent hydrocephalus. Multiple clinical and radiological indices were used throughout the follow up period and statistical significance of each was measured. results: Shunt placement was required in 45 (46.88 %) of the 96 patients. Eighteen patients (18.75%) needed the shunt as soon as they presented to us (group A), because xi they were having clinically active hydrocephalus