Non-closure of open neural tube defects above L2 in 105 infants born between 1978 and 1985 resulted in a significantly lower incidence (p < 0.001) of hydocephalus, shunt insertions, and ventriculitis during the first few months of life, and mortality was not increased throughout the first year, in a study reported from the Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland. This non-closure or deferred-closure group was compared with 109 infants born between 1964 and 1971 whose open neural tube defects were treated by early closure. Hydrocephalus correlated with the occurrence of ventriculitis (p < 0.001) during the first year of life in both non-closure and early-closure groups; 37 of 72 infants with hydrocephalus developed ventriculitis compared with 6 of 37 without hydrocephalus in those whose defect was not closed, and results were similar in those who received early closure. The authors conclude that non-closure of neural tube defects is associated with a better prognosis and a reduction in the number of shunt operations and revisions. [1]

COMMENT. A rate of infection of 20% or higher is reported with the operative treatment of hydrocephalus (see Ped Neur Briefs, Sept 1987; l(4): 28), and patients with myelomeningocele are most susceptible. In those shunted at 1 week of age or earlier, the rate of infection was 48% but when shunting was performed at 2 weeks or later, the incidence of infection was lower. Since non-closure of myelomeningocele appears to be safe and reduces the necessity for shunt procedures, this method of management should be preferred. However, I am sure that other pediatric neurosurgeons have opposing opinions.