If the shunt is not placed during back closure, what will the neurosurgeon do?

• A. Wait and monitor head circumference and lateral ventricle size to determine when to insert a shunt
• B. Immediately repeat back closure
• C. Place a shunt in the future during subsequent surgeries
• D. Ignore head measurements

Answer: (A)

When a shunt isn’t placed during the initial back closure in a baby with this condition, the plan is to monitor closely for signs of hydrocephalus and treat it if it develops. The neurosurgeon uses serial head measurements and brain imaging to track changes in ventricular size. If the ventricles enlarge or the head grows rapidly, indicating rising pressure from hydrocephalus, a ventriculoperitoneal shunt is then placed, usually at a later, planned time. This approach avoids unnecessary shunt placement while ensuring timely intervention if hydrocephalus progresses. Ignoring head growth or ventricle size would miss developing hydrocephalus, and reopening the closure immediately isn’t the standard course when there isn’t an immediate shunt need.