One-stage meningomyelocele closure and ventriculoperitoneal shunt placement.

Thirteen myelodysplastic neonates were observed to have birth head circumferences below the 90th percentile but ventriculomegaly on preoperative computed tomograms. These infants all required later shunting for hydrocephalus. We then began performing a one-stage procedure of meningomyelocele closure and shunt insertion in all neonates with ventriculomegaly on preoperative computed tomograms without regard to head circumference. Seventeen of 24 additional patients have had the one-stage procedure; 4 have required later shunting; 1 shunt infection (6%) was encountered. We conclude that neonatal head circumference does not predict hydrocephalus, and that ventriculomegaly on preoperative computed tomograms identifies neonates who will require shunting.