gms | German Medical Science

Objective: More than 80% of children with open spina bifida are expected to develop hydrocephalus eventually requiring a shunt system. To our knowledge there are no long-term follow-up studies especially on shunt function in older patients with spina bifida.

Methods: We reviewed 69 patients previously operated on for open spina bifida. From this group 61 patients received a shunt system. We investigated the function of the shunt taking into account neurological, ophthalmological and radiological findings. Follow-up in months ranged from 2 to 439 with a median of 115 months.

Results: 88% of the patients required a shunt. Mostly ventriculo-peritoneal shunts were placed. 5 patients (age 24–39) were clinically stable with radiologically doubtful position of the distal catheter or after a shunt removal for other reasons before. With 3 patients shunt revision was necessary due to clinical symptoms of intracranial hypertension or hypotension confirmed by radiological studies showing disconnection in 2 and valve failure in 1 patient.

Conclusions: Despite shunt dependency in a high percentage (88%) in childhood later on in life a variety of clinical and radiological findings are to be expected requiring individual evaluation. In our group of 61 patients 5 patients (8%) showed longstanding clinical stability with a disconnected or displaced or removed shunt. A close clinical follow up including EEG recording and fundoscopy in this group appears advisable. Signs of shunt malfunction were noted in 2 patients after a long interval of 22 and 30 years after first shunt placement.