الفهرس 
MyelomeningoceleOnly 14 pages are availabe for public view
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Abstract
Patients with MMC typically express some degree of ventriculomegaly after the closure of the defect; some of them will have compensated &/or arrested hydrocephalus, while others will have progressing hydrocephalus.
AF status & HC percentile for age represent the most reliable clinical signs to identify those who will need & benefit from a CSF diversion.
Also, persistent vomiting is a highly statistically significant and sensitive indicator of increased ICP in MMC babies.
The sun-setting appearance of the eyes together with initially delayed developmental milestones or those who showed deterioration of the previously attained milestones are highly statistically significant criteria to predict the need for a shunt but are delayed signs.
Before the life-long shunt surgery, ETV-CPC can control hydrocephalus in 60% of SBM & should be the first line of treatment of these cases.
The VP shunt should be preserved for cases exhibiting progressive signs of increased ICP (moderate to severe AF bulge- HC crossing percentile for age), while cases showing ventriculomegaly on imaging without signs of increased ICP should be followed up.