Shunt fracture in two children with myelomeningocele following spine surgery.

Sir, Most neonates with myelomeningocele (MMC) develop symptomatic hydrocephalus within the first 6 weeks of life. Ventriculoperitoneal (VP) shunt surgery is the most frequent operation, which is used in order to treat hydrocephalus.[11] Shunt failure rate is estimated as high as 40% by 1 year and 50% by 2 years and 70% after the fifth year.[2,5,6] According to current data, approximately 56–80% of the patients experience at least one episode of malfunction during the 10 years following insertion.[8,10] The non-infectious causes of shunt failure include obstruction, overdrainage, loculation of the ventricles, abdominal complications and mechanical failure including fracture and kinking of the tube, disconnection of components, migration of the shunt or misplacement.[9] The typical presentation of a fractured shunt system is usually quite late after initial insertion and it may be marked by the rapid onset of dramatic symptoms such as headache, nausea, swelling over the shunt tract often in a location over the shunt fracture or it may occur in a more subtle fashion over a longer period of time.[1] Here, we report two children with shunted hydrocephalus and history of MMC who presented with acute shunt malfunction related to distal tube fracture shortly following the spinal surgery.