David F Bauer1, Alexandra D Beier2, Dimitrios C Nikas3, Nadege Assassi4, Jeffrey Blount5, Susan R Durham6, Ann Marie Flannery7, Paul Klimo8,9,10, Catherine McClung-Smith11, Patricia Rehring12, Mandeep S Tamber13, Rachana Tyagi14, Catherine A Mazzola15. 1. Department of Surgery, Division of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. 2. Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida. 3. Division of Pediatric Neurosurgery, Advocate Children's Hospital, Oak Lawn, Illinois. 4. Department of Surgery, Division of Neurosurgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey. 5. Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama. 6. Division of Neurosurgery, University of Vermont, Burlington, Vermont. 7. Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana. 8. Semmes Murphey, Memphis, Tennessee. 9. Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee. 10. Le Bonheur Children's Hospital, Memphis, Tennessee. 11. Department of Neurological Surgery, Palmetto Health USC Medical Group, Columbia, South Carolina. 12. Congress of Neurological Surgeons, Schaumburg, Illinois. 13. Division of Pediatric Neurosurgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada. 14. Department of Neurosurgery, Mercer University Medical School, Macon, Georgia. 15. Goryeb Children's Hospital, Morristown, New Jersey; Rutgers Department of Neurological Surgery, Newark, New Jersey.
Abstract
BACKGROUND: Myelomeningocele (MM) is an open neural tube defect treated by pediatric neurosurgeons with prenatal or postnatal closure. OBJECTIVE: The objective of this systematic review was to answer the question: What is the evidence for the effectiveness of prenatal vs postnatal closure of MM regarding short and long-term ambulatory status? Treatment recommendations were provided based on the available evidence. METHODS: The National Library of Medicine PubMed database and Embase were queried using MeSH headings and keywords relevant to ambulatory status after prenatal or postnatal closure of MM. Abstracts were reviewed to identify which studies met the inclusion criteria. An evidence table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). RESULTS: One randomized controlled trial (Class II) and 3 retrospective cohort studies (Class III) were included as evidence. Initial ambulatory status depended on anatomic level of the neural tube defect. In the short term, prenatal closure may improve ambulatory status compared to postnatal closure. Spinal cord tethering or dermoid inclusion cyst has been associated with neurologic deterioration in infants closed in utero and after birth. Ambulation may cease in both groups over time. No long-term studies evaluated whether there is a difference in the ability to ambulate upon reaching adulthood. CONCLUSION: Prenatal closure of MM may improve ambulatory status in the short term (Level II). Spinal cord tethering in both groups caused deterioration in the ability to walk. Evaluation and treatment of spinal cord tethering may help maintain ambulatory status (Level III). No studies evaluate whether prenatal or postnatal repair provides improved ability to ambulate upon reaching adulthood.The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-3.
BACKGROUND: Myelomeningocele (MM) is an open neural tube defect treated by pediatric neurosurgeons with prenatal or postnatal closure. OBJECTIVE: The objective of this systematic review was to answer the question: What is the evidence for the effectiveness of prenatal vs postnatal closure of MM regarding short and long-term ambulatory status? Treatment recommendations were provided based on the available evidence. METHODS: The National Library of Medicine PubMed database and Embase were queried using MeSH headings and keywords relevant to ambulatory status after prenatal or postnatal closure of MM. Abstracts were reviewed to identify which studies met the inclusion criteria. An evidence table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). RESULTS: One randomized controlled trial (Class II) and 3 retrospective cohort studies (Class III) were included as evidence. Initial ambulatory status depended on anatomic level of the neural tube defect. In the short term, prenatal closure may improve ambulatory status compared to postnatal closure. Spinal cord tethering or dermoid inclusion cyst has been associated with neurologic deterioration in infants closed in utero and after birth. Ambulation may cease in both groups over time. No long-term studies evaluated whether there is a difference in the ability to ambulate upon reaching adulthood. CONCLUSION: Prenatal closure of MM may improve ambulatory status in the short term (Level II). Spinal cord tethering in both groups caused deterioration in the ability to walk. Evaluation and treatment of spinal cord tethering may help maintain ambulatory status (Level III). No studies evaluate whether prenatal or postnatal repair provides improved ability to ambulate upon reaching adulthood.The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-3.
Authors: Stefanie P Lazow; Daniel F Labuz; Benjamin R Freedman; Anna Rock; David Zurakowski; David J Mooney; Dario O Fauza Journal: J Pediatr Surg Date: 2020-10-03 Impact factor: 2.545