Abstract：
To discern the efficacy of simultaneous versus delayed VPS surgery in managing hydrocephalus linked with MMC repair: The debate over the concurrent or deferred placement of ventriculoperitoneal shunts (VPS) during myelomeningocele (MMC) repair in hydrocephalic neonates necessitates a nuanced evaluation of associated risks and benefits. While VPS placement can mitigate cerebrospinal fluid (CSF) leaks and minimize wound dehiscence post-MMC repair, it concurrently introduces potential hazards such as infections and shunt-related malfunctions. This prospective cohort study focused on144 newborns with spinal myelomeningocele and hydrocephalus. Divided into two groups based on the timing of dysraphism repair and VPS placement, 101 children underwent concurrent procedures, while 43 received deferred VPS insertion post-MMC closure. Female patients constituted 60% of the cohort, with lumbar lesions being predominant. The median age for MMC closure was three days. Analysis revealed that the deferred insertion group exhibited higher rates of shunt malfunctions, CSF leaks, and wound dehiscence compared to the concurrent insertion group. Although indications hinted at a potential increase in shunt infections in the immediate insertion group, statistical significance was lacking. The study established a statistically significant association between the timing of shunt insertion during MMC repair and specific outcomes, such as CSF leaks and wound dehiscence. The findings suggest that concurrent shunt insertion during MMC repair may reduce the incidence of these complications compared to deferred insertion. However, no substantial differences emerged in terms of shunt infection and malfunction, emphasizing the persistent challenges associated with these major complications.
摘要：
为了辨别同步VPS手术与延迟VPS手术在治疗与MMC修复相关的脑积水中的功效：关于脑积水新生儿脊髓膜膨出（MMC）修复期间同时或延迟放置脑室腹膜分流器（VPS）的争论需要对相关风险和收益进行细致的评估。虽然VPS放置可以减轻脑脊液（CSF）泄漏并减少MMC修复后的伤口裂开，它同时引入了潜在危险，如感染和分流相关故障。这项前瞻性队列研究的重点是144例患有脊髓脊膜膨出和脑积水的新生儿。根据发育不良修复和VPS放置的时间分为两组，101名儿童接受了并行手术，而43人在MMC关闭后接受了延迟的VPS插入。女性患者占队列的60％，以腰椎病变为主.MMC关闭的中位年龄为3天。分析显示，延迟插入组表现出更高的分流故障率，脑脊液泄漏,与同时插入组相比，伤口裂开。尽管适应症暗示了立即插入组中分流感染的潜在增加，缺乏统计学意义。该研究建立了MMC修复期间分流插入的时间和具体结果之间的统计学显著关联。如脑脊液渗漏和伤口裂开。研究结果表明，与延迟插入相比，MMC修复期间同时插入分流可能会降低这些并发症的发生率。然而,在分流感染和故障方面没有实质性差异，强调与这些主要并发症相关的持续挑战。
