836 Value of Clinical and Ultrasonic Parameters as Preoperative Predictors of Risk of Developing Hydrocephalus Post Myelomeningocele Repair: A Cohort Study

INTRODUCTION: The risk of developing hydrocephalus after myelomeningocele repair may be determined by using preoperative clinical and transcranial ultrasound parameters. METHODS: A prospective longitudinal cohort study from November 2016 to October 2018, that involved 28 patients with myelomeningocele who presented to a tertiary hospital in southwestern Nigeria. Transcranial ultrasound was done before myelomeningocele repair and patients followed up for six months to detect hydrocephalus. Analysis of the state of the anterior fontanelle, the occipitofrontal circumference (OFC), ventricular index, bicaudate diameter, lateral ventricular ratio, thalamo-occipital distance and maximum transverse lateral ventricular diameter were done to determine their predictive values for the development of hydrocephalus after myelomeningocele repair. RESULTS: Age range was 1 -120 days with a mean of 20 days and the average age at the time of myelomeningocele repair was 23 days. There were 16 (57.1%) females and 12(42.9%) males in the study. OFC range at presentation was 31- 42cm with a mean of 34.7cm ±2.6 SD. The probability that a patient will develop hydrocephalus after myelomeningocele repair increased by 1.74 times for every1cm increase in the OFC above 34.5cm before myelomeningocele repair, p= 0.03. However, the state of the anterior fontanelle as well as the trans cranial ultrasound parameters were not found to be predictors of hydrocephalus post myelomeningocele repair. CONCLUSIONS: The OFC of the patients before myelomeningocele repair was predictive of development of hydrocephalus post repair, but the state of the anterior fontanelle and pre-operative trans fontanelle ultrasound parameters were not.