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The majority of children with myelomeningocele will have associated hydrocephalus. The management of hydrocephalus can be one of the most trying problems in this patient population. Cerebrospinal fluid (CSF) diversion will be required in these children for the remainder of their lives. Blockage of the outlets of the fourth ventricle and communication of the fourth ventricle with the central canal provides a mechanism for compensation. The signs and symptoms of CSF diversion malfunction, either shunt or third ventriculostomy, can be quite subtle. The objective indications of these malfunctions are less available after third ventriculostomy than when using mechanical shunting. The ease with which the diagnosis of malfunction can be made becomes the major advantage of mechanical shunting over third ventriculostomy.
The majority of children with myelomeningocele will have associated hydrocephalus. The management of the hydrocephalus can be one of the most trying problems in this patient population. Cerebrospinal fluid diversion will be required in these children for their entire lives. Whether they are treated in the classic fashion with a ventricular shunt or a third ventriculostomy is performed, they will be dependent on CSF diversion. There are several dilemmas in their treatment from timing of the initial shunt placement to the diagnosis and treatment of shunt malfunction or third ventriculostomy failure. These issues and the advantages of mechanical shunting over CSF diversion by third ventriculostomy will be discussed.
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