Anemia of Prematurity - Portal Neonatal

placement of a shunt during the same operation for closure of a myelomeningocele is entirely
reasonable. At the author's institution, patients who manifest ventriculomegaly after birth undergo
shunt placement after myelomeningocele closure but while under the same anesthetic. Shunt
placement not only decreases future anesthetic risk, but also it decreases the chance of CSF leaking
through the myelomeningocele closure.
Treatment of Chiari II malformations
In CM II, decompression of the posterior fossa and/or cervical cord, with its variable anatomy, is
surgically challenging and requires an experienced surgeon. The torcular can come in low near the
foramen magnum, the cerebellum often is adherent to the medulla, and there are many venous
sinuses. Catastrophic blood loss is the major risk when a sinus is inadvertently opened. Prior to
decompressing a CM II, ensure the shunt is functioning. CT scan findings can be misleading, as
ventricles can remain small despite an obstruction in the shunt. Shunt tap or exploration is the most
reliable test prior to embarking on a Chiari decompression.
The main signs and symptoms of a CM II that requires decompression are those of brainstem
compression. For example, neonates can have stridor, central apnea, dysphagia, quadriparesis, or
failure to thrive. Patients may have subtle signs, such as worsening strabismus, nystagmus,
myelopathy, or aspiration of unclear etiology. Symptomatic CM II is the leading cause of death in our
patients with myelomeningocele. (Approximately 30% of children die that develop brainstem
symptoms when