Nicholas M B Laskay1, Anastasia A Arynchyna1, Samuel G McClugage1, Betsy Hopson1, Chevis Shannon2, Benjamin Ditty1, John C Wellons2, Jeffrey P Blount1, Brandon G Rocque3. 1. Department of Neurological Surgery, Division of Pediatric Neurosurgery, The University of Alabama at Birmingham, 1600 7th Ave. S, Lowder 400, Birmingham, AL, 35233, USA. 2. Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA. 3. Department of Neurological Surgery, Division of Pediatric Neurosurgery, The University of Alabama at Birmingham, 1600 7th Ave. S, Lowder 400, Birmingham, AL, 35233, USA. brandon.rocque@childrensal.org.
Abstract
PURPOSE: We evaluate a single-institution cohort of mothers contemporaneous with the Management of Myelomeningocele Study (MOMS) trial to determine the generalizability of MOMS results and compare shunt rates. METHODS: A retrospective chart review identified patients with myelomeningocele born between 2003 and 2009. We applied MOMS eligibility criteria and compared sociodemographic variables between patients at our institution who would have been eligible or ineligible and MOMS participants. Finally, we applied the original MOMS primary outcome and the revised primary outcome to our cohort. RESULTS: Of the 78 patients, 55 (70.5%) were eligible for the MOMS trial. Mean maternal age, race, and marital status were different from both MOMS groups. Comparing our series to MOMS postnatal shows fewer female infants (44.9 vs. 63.8%, p = 0.017) and more thoracic lesions (12.8 vs. 3.8%, p = 0.038). Shunt rates in our cohort (84.6%) were higher than MOMS prenatal and similar to MOMS postnatal (44.0 and 83.7%, respectively). Fewer children met the original primary outcome than the postnatal group (84.6 vs. 97.8%, p = 0.002). There was no significant difference between our cohort and the prenatal group (84.6 vs. 72.5%, p = 0.058). When applying the revised criteria, we find the opposite: a significant difference between local and MOMS prenatal (84.6 vs. 49.5%, p < 0.001) but no difference between the local group and MOMS postnatal (84.6 vs. 87.0%, p = 0.662). CONCLUSIONS: Mothers in our cohort differ from mothers enrolled in MOMS via several sociodemographic factors. Baseline fetal characteristics show a significantly higher functional lesion level in between our cohort and MOMS. Treatment of hydrocephalus in our series tracks almost identically with original MOMS shunt criteria. Revision of the criteria led to greater concordance between meeting criteria and receiving a shunt in MOMS patients, but changes the results in our series.
PURPOSE: We evaluate a single-institution cohort of mothers contemporaneous with the Management of Myelomeningocele Study (MOMS) trial to determine the generalizability of MOMS results and compare shunt rates. METHODS: A retrospective chart review identified patients with myelomeningocele born between 2003 and 2009. We applied MOMS eligibility criteria and compared sociodemographic variables between patients at our institution who would have been eligible or ineligible and MOMSparticipants. Finally, we applied the original MOMS primary outcome and the revised primary outcome to our cohort. RESULTS: Of the 78 patients, 55 (70.5%) were eligible for the MOMS trial. Mean maternal age, race, and marital status were different from both MOMS groups. Comparing our series to MOMS postnatal shows fewer female infants (44.9 vs. 63.8%, p = 0.017) and more thoracic lesions (12.8 vs. 3.8%, p = 0.038). Shunt rates in our cohort (84.6%) were higher than MOMS prenatal and similar to MOMS postnatal (44.0 and 83.7%, respectively). Fewer children met the original primary outcome than the postnatal group (84.6 vs. 97.8%, p = 0.002). There was no significant difference between our cohort and the prenatal group (84.6 vs. 72.5%, p = 0.058). When applying the revised criteria, we find the opposite: a significant difference between local and MOMS prenatal (84.6 vs. 49.5%, p < 0.001) but no difference between the local group and MOMS postnatal (84.6 vs. 87.0%, p = 0.662). CONCLUSIONS: Mothers in our cohort differ from mothers enrolled in MOMS via several sociodemographic factors. Baseline fetal characteristics show a significantly higher functional lesion level in between our cohort and MOMS. Treatment of hydrocephalus in our series tracks almost identically with original MOMS shunt criteria. Revision of the criteria led to greater concordance between meeting criteria and receiving a shunt in MOMSpatients, but changes the results in our series.
Entities:
Keywords:
Chiari II malformation; Hydrocephalus; Management of Myelomeningocele Study; Myelomeningocele; Shunt
Authors: M A G C Schoenmakers; C S P M Uiterwaal; V A M Gulmans; R H J M Gooskens; P J M Helders Journal: Clin Rehabil Date: 2005-09 Impact factor: 3.477
Authors: N Scott Adzick; Elizabeth A Thom; Catherine Y Spong; John W Brock; Pamela K Burrows; Mark P Johnson; Lori J Howell; Jody A Farrell; Mary E Dabrowiak; Leslie N Sutton; Nalin Gupta; Noel B Tulipan; Mary E D'Alton; Diana L Farmer Journal: N Engl J Med Date: 2011-02-09 Impact factor: 91.245
Authors: Rachel Burmeister; H Julia Hannay; Kim Copeland; Jack M Fletcher; Amy Boudousquie; Maureen Dennis Journal: Child Neuropsychol Date: 2005-06 Impact factor: 2.500
Authors: Noel Tulipan; John C Wellons; Elizabeth A Thom; Nalin Gupta; Leslie N Sutton; Pamela K Burrows; Diana Farmer; William Walsh; Mark P Johnson; Larry Rand; Susan Tolivaisa; Mary E D'alton; N Scott Adzick Journal: J Neurosurg Pediatr Date: 2015-09-15 Impact factor: 2.375
Authors: Varun R Kshettry; Michael L Kelly; Benjamin P Rosenbaum; Andreea Seicean; Lee Hwang; Robert J Weil Journal: J Neurosurg Pediatr Date: 2014-04-04 Impact factor: 2.375
Authors: Irene Kim; Betsy Hopson; Inmaculada Aban; Elias B Rizk; Mark S Dias; Robin Bowman; Laurie L Ackerman; Michael D Partington; Heidi Castillo; Jonathan Castillo; Paula R Peterson; Jeffrey P Blount; Brandon G Rocque Journal: J Neurosurg Pediatr Date: 2018-12-01 Impact factor: 2.375