Investigation of the Relationship Among the Anatomical Level of the Lesion, Hydrocephalus and Chiari Type 2 Pathologies in Myelomeningocele Patients

Abstract

Objective: The coexistence of hydrocephalus and Chiari II malformation significantly increases mortality in patients with myelomeningocele (MMS). This study aimed to investigate the factors associated with the development of hydrocephalus and Chiari II malformation in patients with MMS. Methods: A total of 430 patients who were hospitalized and underwent surgery for MMS in the neurosurgery unit of our hospital were retrospectively evaluated. Data collected included gender, maternal age, lesion level, sac size, presence of hydrocephalus or Chiari II malformation, and the need for shunt placement. Univariate and multivariate statistical analyses were performed to examine the relationships between patient characteristics and the development of hydrocephalus and Chiari II malformation. Findings: Of the 430 patients, 227 (52.8 %) were female and 203 (47.2 %) were male. Hydrocephalus developed in 298 patients (69.3 %), while 218 (50.7 %) were diagnosed with Chiari II malformation. The most common lesion level was the lumbar region (61.4 %). In multivariate analysis, the risk of developing hydrocephalus was 8.58 times higher in patients with thoracic-cervicothoracic lesions and 2.65 times higher in those with thoracolumbar lesions. Gender and sac size were not significantly associated with the development of hydrocephalus (p = 0.181 and p = 0.077, respectively). Univariate analysis showed no significant association between lesion level and the development of Chiari II malformation (p = 0.971). Conclusion: In patients with MMS, lesion level is an independent risk factor for the development of hydrocephalus. Children with thoracic, cervicothoracic, and thoracolumbar lesions—especially those with Chiari II malformation—should be closely monitored for hydrocephalus development. © 2025 Elsevier B.V., All rights reserved.