Fetal Care Center of Cincinnati

Postnatal Indications

Postnatal Indications for Ventriculoperitoneal Shunting

In order to standardize the approach to postnatal management so they can be benchmarked against the results reported by the MOMS trial will be the same criteria for ventriculoperitoneal shunt insertion:

1. At least two of the following:
• An increase in the greatest occipital-frontal circumference adjusted for gestational age defined as crossing percentiles.  Patients who cross centiles and subsequently plateau do not meet this criteria
• A bulging fontanelle (defined as above the bone assessed when the baby is in an upright position and not crying) or split sutures or sunsetting sing (eyes appear to look downward with the sclera prominent over the iris)
• Increasing hydrocephalus on consecutive imaging studies determined by increase in ratio of biventricular diameter to biparietal diameter according to the method of O’Hayon et al. (O’Hayon BB, Drake JM, Ossip MG, et al. Frontal and occipital horn ratio: a linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus. Pediatr Neurosurg. 1998; 29:245-9).
• Head circumference >95^th percentile for gestational age

     or

2. Presence of marked syringomyelia (syrinx with expansion of spinal cord) with ventriculomegaly (undefined).

    or

3. Ventriculomegaly (undefined) and symptoms of Chiari malformation (stridor, swallowing difficulties, apnea, bradycardia)

    or

4. Persistent cerebrospinal fluid leakage from the myelomeningocele wound or building at the repair site.