Long-term outcome of XXXX management in myelomeningoceles.

@entity1 @entity281 @entity1276
BACKGROUND: The cerebrospinal fluid (CSF) shunt remains an important ongoing management problem in myelomeningocele (MMC) @entity1 . We reviewed the long-term shunt treatment outcome in a prospectively followed group of MMC @entity1 from a single institution. METHOD: @entity1 prospectively entered into a @entity1276 database with a diagnosis of MMC from the years 1987 to 1996 were selected. All data was verified from the medical records and additional details about the shunt surgery were collected. The outcome of shunt failure was categorized as shunt obstruction, @entity281 , presence of loculated ventricles, overdrainage, and other. All deaths were recorded and causation identified. Univariate analysis for shunt failure risk factors was accomplished using Log rank statistics. Multivariable analysis was performed for each repeated failure level using a conditional Cox regression model. RESULTS: One hundred and twenty (64%) out of 189 MMC @entity1 experienced a first shunt failure with a median time of 303 days; 29 (24%) of the failures were due to @entity281 (the procedure infection rate being 15%). Sixty-one @entity1 experienced a second shunt failure, 38 a third and 36 had four or more. Multivariable analysis of risk factors failed to demonstrate any clear risk factors for either first or subsequent shunt failure. Fifteen @entity1 died, 13 from either shunt or Chiari 1 complications. CONCLUSION: Shunt complications remain an important cause of morbidity and mortality in MMC @entity1 , particularly @entity281 .
