Congenital myelomeningocele - do we have to change our management?

Table 1 Criteria for shunt placement

Criteria for Shunt placement (MOMS trial)
At least two of the following:	Or:
An increase in the greatest occipitofrontal circumference adjusted for gestational age and defined as crossing percentiles	Head circumference > 95^th percentile for gestational age
A bulging fontanelle*, split sutures or sunsetting sign	Presence of marked syringomyelia (syrinx and expansion of spinal cord) and ventriculomegaly (undefined)
Increasing hydrocephalus on two consecutive imaging studies determined by an increase in ratio of biventricular diameter to biparietal diameter^§	Ventriculomegaly (undefined) and symptoms of Chiari malformation (stridor, swallowing difficulties, apnea, bradycardia)
	Persistent cerebrospinal fluid leakage from the myelomeningocele wound or bulging at the repair site

Criteria for shunt placement as defined for the MOMS trial. *Bulging fontanelle: above the bone as assessed when the baby is in an upright position and not crying. ^§Defined by O'Hayon et al, 1998 [34]. Table adapted from Tulipan et al, 2004 [35].

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