Is shunt series X-ray necessary before revision of obstructed ventriculoperitoneal shunt?

The purpose of this study is to estimate whether routine preoperative shunt series [POSS] lead to clinically relevant new information, that helps in the management of ventriculoperitoneal shunt [VPS] obstruction, focusing on its role in diagnosing mechanical causes of shunt obstruction. Retrospective review of 64 consecutive patients who underwent revision of obstructed VPS in the neurosurgery division, at King Saud University, Riyadh, Saudi Arabia, between June 2002 and December 2011, assessing the proportion and impact of abnormal findings in the POSS. Sixty-nine POSS were performed for 64 patients before revision of obstructed VPS. Their mean age was 11.8 years, and 25 patients among them were females. Seventeen [24.6%] POSS had abnormal finding, that was statistically significant [P =0.005], and only 10 of them influenced the surgical technique or choice of therapeutic procedure [P =0.0001]. Positive findings were in the form of; broken/disconnected catheter [n =4], intra-abdominal migration of peritoneal catheter [n= 4], coiled/extra-peritoneal distal catheter [n= 2], short peritoneal end [n=1], and retained catheter/more than one shunt [n= 6]. However, majority of shunt series [75.4%] were normal. Routine shunt series X-ray alone is not a diagnostic tool for shunt malfunction, and POSS should be reserved for patients with proven shunt failure on CT or MRI scan. There was a significant impact of POSS on the operative decision for those undergoing revision for VPS obstruction.

Split cord malformation associated with spinal open neural tube defect

To illustrate the clinical and radiological findings of split cord malformation [SCM] in patients with spinal open neural tube defect [SONTD], and report the outcome of their treatment. A retrospective study of the clinical and radiological findings of 11 patients diagnosed with SCM, identified among 83 patients with SONTD at King Khalid University Hospital, in Riyadh, Saudi Arabia between 1995 and 2010. There were 6 girls and 5 boys; their age ranged from less than a year to 9 years [mean 4.2 years]. Six patients had type I SCM, and 5 patients type II SCM. The CT and MRI imaging showed characteristic bony, cartilaginous, or fibrous septum, and other SONTD-associated anomalies. Seven patients were graded A and B according to the Frankel grading score, and none of them required surgery, while worsening neurology led to surgical intervention in 3 patients, with clinical improvement after surgery, and one patient that underwent cord untethering remained stable. Split cord malformation is not uncommon among patients with SONTD. It tends to involve mainly the lumbar spine, and female predominance is more remarkable in type I. Neurological manifestations of SCM may be superimposed with SONTD. Surgery is effective for symptomatic patients, and not indicated in the severely disabled.

Agenesis of the corpus callosum associated with spinal open neural tube defect

To ascertain the incidence and clinical implications of agenesis of the corpus callosum [ACC] in spinal open neural tube defects [SONTD]. All cases of SONTD registered at the Spina Bifida Clinic in King Khalid University Hospital, Riyadh, Saudi Arabia between 1995 and 2010 were retrospectively reviewed, and mid-sagittal MRI of the corpus callosum [CC] area was analyzed in each case. Neurodevelopmental outcome was classified as poor in children with seizures, severe neurodevelopmental impairment, or death. Thirty-eight patients [45.8%] with ACC were identified among 83 cases with SONTD. Patients' age ranged between one and 16 years. Total ACC was found in 10 patients, partial ACC in 25, and in 3 patients, the CC was hypoplastic. Active hydrocephalus was an associated finding in 9 out of 10 patients with total ACC, 22 out of 25 with partial ACC, and in all patients with hypoplasia of the CC. Thirteen patients [34.2%] had normal intellectual function, whereas 24 patients presented with learning disability, epilepsy, or poor intellectual function; and one patient died of respiratory failure. Agenesis of the corpus callosum is found in a significant portion of patients with SONTD. When associated with hydrocephalus, its presence affects neuro-developmental outcome.