207. Myelomeningocele Associated Hydrocephalus: Nationwide Analysis And Systematic Review

Authors: Evan Luther, MD; David McCarthy, MSc; Dallas Sheinberg, MSc; Heather McCrea, MD, PhD (Miami, FL)

Introduction:

The management/prevention of myelomeningocele (MMC) associated hydrocephalus has evolved overtime especially regarding treatment of MMC defects, MMC associated hydrocephalus treatment modality, and timing of hydrocephalus treatment.

Methods:

The Nationwide Inpatient Sample (NIS) from 1998-2014 was reviewed and neonates with Spina Bifida and hydrocephalus were identified. Timing of hydrocephalus treatment (delayed (DT) versus simultaneous treatment with MMC repair (ST)) and treatment modality (ETV versus VPS) were analyzed. Yearly trends were assessed with univariable logarithmic regression. Multivariable logistic regression identified correlates of inpatient shunt failure. A systematic literature review analyzed data from studies that investigated (1) MMC closure techniques/hydrocephalus rates, (2) hydrocephalus treatment modalities, and (3) timing of hydrocephalus treatment.

Results:

10,627 inpatient MMC repairs were documented in the NIS. 8,233 (77.5%) had documented hydrocephalus: 5,876 (71.4%) were treated with VPS, 331 (4.0%) were treated with ETV, and 2,026 (24.6%) remained untreated on initial inpatient stay. Treatment modality rates were stable overtime; however, hydrocephalic patients in later years were less likely to receive hydrocephalus treatment during initial inpatient stay (OR 0.974, p=0.0331). Inpatient hydrocephalus treatment failure rate was higher for patients who received ETV treatment (17.5% ETV failure rate vs. 7.9% VPS failure rate; p= 0.0028). Delayed hydrocephalus treatment was more prevalent in later years (77.9% vs. 69.5%, p=0.0287). Inpatient shunt failure predictors included length of stay, shunt infection, jaundice, and delayed treatment. Longer time between operations increased likelihood of inpatient shunt failure (OR 1.10, p< 0.0001). However, a meta-analysis of hydrocephalus timing studies revealed no difference between ST and DT with respect to shunt failure or infection rates.

Conclusion:

From 1998-2014 hydrocephalus treatment has become more delayed and the number of hydrocephalic MMC patients not treated on initial inpatient stay has increased. Meta-analysis demonstrated that shunt malfunction and infection rates do not differ between delayed and simultaneous hydrocephalus treatment.