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Abstract

Background: Cerebrospinal fluid (CSF) leakage is a significant complication following meningomyelocele (MMC) repair, potentially leading to infections and poor surgical outcomes. The role of ventriculoperitoneal (VP) shunt placement in reducing CSF leaks remains a topic of debate. Understanding the impact of VP shunts on CSF leak rates can help optimize neurosurgical management strategies in neonates undergoing MMC repair. Objective: To compare the incidence of CSF leaks in neonates undergoing MMC repair with and without VP shunt placement. Study Design: Descriptive analysis. Setting: The study was conducted in the Department of Neurosurgery at Lady Reading Hospital, Peshawar. Duration of Study: This study was conducted from August 04, 2024, to February 04, 2025. Methods: A total of 100 neonates (aged 1 to 28 days) diagnosed with MMC were enrolled. Exclusion criteria included neonates with a low Apgar score (less than 5) and those whose parents declined consent. All neonates underwent standard neurosurgical closure of the MMC defect within 24 hours of admission. Patients were categorized into two groups: those who received a VP shunt (n = 72) and those who did not (n = 28). CSF leaks were assessed clinically based on the presence of osseous defects with fluid leakage. The incidence of CSF leaks was compared between the two groups using statistical analysis. A p-value of less than 0.05 was considered statistically significant. Results: The mean age of neonates was 13.73 ± 8.22 days. Among the 100 neonates, VP shunts were placed in 72, while 28 did not receive shunts. The overall incidence of CSF leaks was 9%. A significant difference in CSF leak rates was observed between the groups: only 2.8% of neonates with VP shunts developed CSF leaks compared to 25% of those without VP shunts (p = 0.0001), indicating a strong protective effect of VP shunt placement. Conclusion: This study demonstrates that VP shunt placement significantly reduces the incidence of CSF leaks in neonates undergoing MMC repair. Neonates who did not receive VP shunts had a markedly higher rate of CSF leaks, highlighting the potential benefit of early VP shunt placement in improving postoperative outcomes. Further studies with larger cohorts are warranted to validate these findings and guide clinical decision-making.