Although the majority of patients with myelomeningocele have hydrocephalus, reported rates of hydrocephalus treatment vary widely. The purpose of this study was to determine the rate of surgical treatment for hydrocephalus in patients with myelomeningocele in the National Spina Bifida Patient Registry (NSBPR). In addition, the authors explored the variation in shunting rates across NSBPR institutions, examined the relationship between hydrocephalus, and the functional lesion level of the myelomeningocele, and evaluated for temporal trends in rates of treated hydrocephalus.
The authors queried the NSBPR to identify all patients with myelomeningoceles. Individuals were identified as having been treated for hydrocephalus if they had undergone at least 1 hydrocephalus-related operation. For each participating NSBPR institution, the authors calculated the proportion of patients with treated hydrocephalus who were enrolled at that site. Logistic regression was performed to analyze the relationship between hydrocephalus and the functional lesion level of the myelomeningocele and to compare the rate of treated hydrocephalus in children born before 2005 with those born in 2005 or later.
A total of 4448 patients with myelomeningocele were identified from 26 institutions, of whom 3558 patients (79.99%) had undergone at least 1 hydrocephalus-related operation. The rate of treated hydrocephalus ranged from 72% to 96% among institutions enrolling more than 10 patients. This difference in treatment rates between centers was statistically significant (p < 0.001). Insufficient data were available in the NSBPR to analyze reasons for the different rates of hydrocephalus treatment between sites. Multivariate logistic regression demonstrated that more rostral functional lesion levels were associated with higher rates of treated hydrocephalus (p < 0.001) but demonstrated no significant difference in hydrocephalus treatment rates between children born before versus after 2005.
The rate of hydrocephalus treatment in patients with myelomeningocele in the NSBPR is 79.99%, which is consistent with the rates in previously published literature. The authors’ data demonstrate a clear association between functional lesion level of the myelomeningocele and the need for hydrocephalus treatment.
ABBREVIATIONSCDC = Centers for Disease Control and Prevention; MOMS = Management of Myelomeningocele Study; NSBPR = National Spina Bifida Patient Registry.
Correspondence Brandon G. Rocque: University of Alabama at Birmingham, AL. firstname.lastname@example.org.INCLUDE WHEN CITING Published online August 24, 2018; DOI: 10.3171/2018.5.PEDS18161.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
BowmanRM, BoshnjakuV, McLoneDG: The changing incidence of myelomeningocele and its impact on pediatric neurosurgery: a review from the Children’s Memorial Hospital. 25:801–806, 200910.1007/s00381-009-0865-z19326126)| false
KimIHopsonBAbanIRizkEBDiasMSBowmanR: Decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry. J Neurosurg Pediatr [epub ahead of printAugust 24 2018. DOI: 10.3171/2018.5.PEDS18160]
KimI, HopsonB, AbanI, RizkEB, DiasMS, BowmanR, : Decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry. August 24, 2018. DOI: 10.3171/2018.5.PEDS18160])| false
LaskayNMB, ArynchynaAA, McClugageSGIII, HopsonB, ShannonC, DittyB, : A comparison of the MOMS trial results to a contemporaneous, single-institution, postnatal closure cohort. 33:639–646, 20172802859810.1007/s00381-016-3328-3)| false
PhillipsBC, GelsominoM, PownallAL, OcalE, SpencerHJ, O’BrienMS, : Predictors of the need for cerebrospinal fluid diversion in patients with myelomeningocele. 14:167–172, 20142487760410.3171/2014.4.PEDS13470)| false
RintoulNESuttonLNHubbardAMCohenBMelchionniJPasquarielloPS: A new look at myelomeningoceles: functional level, vertebral level, shunting, and the implications for fetal intervention. Pediatrics109:409–4132002
RintoulNE, SuttonLN, HubbardAM, CohenB, MelchionniJ, PasquarielloPS, : A new look at myelomeningoceles: functional level, vertebral level, shunting, and the implications for fetal intervention. 109:409–413, 200210.1542/peds.109.3.409)| false
SawinKJLiuTWardEThibadeauJSchechterMSSoeMM: The National Spina Bifida Patient Registry: profile of a large cohort of participants from the first 10 clinics. J Pediatr166:444–450 450.e12015
SawinKJ, LiuT, WardE, ThibadeauJ, SchechterMS, SoeMM, : The National Spina Bifida Patient Registry: profile of a large cohort of participants from the first 10 clinics. 166:444–450, 450.e1, 2015)| false
TulipanN, WellonsJCIII, ThomEA, GuptaN, SuttonLN, BurrowsPK, : Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement. 16:613–620, 201510.3171/2015.7.PEDS1533626369371)| false