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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Pediatric Myelomeningocele:

Catherine A Mazzola1,2, Nadege Assassi3, Lissa C Baird4

  • 1Goryeb Children's Hospital, Morristown, New Jersey.

Neurosurgery
|August 17, 2019
PubMed

Insights

Spina bifida (SB) is more common globally due to malnutrition and folic acid deficiency. Prenatal repair of myelomeningocele (MM) is now possible, leading to new clinical guidelines for improved infant care.

Area of Science:

  • Neurology
  • Pediatric Surgery
  • Maternal-Fetal Medicine

Background:

  • Spina bifida (SB) incidence is higher in developing nations, linked to malnutrition and folate deficiency.
  • Technological advancements enable prenatal repair of myelomeningocele (MM).

Purpose of the Study:

  • Establish evidence-based clinical recommendations for myelomeningocele (MM) care.
  • Secure multi-disciplinary endorsement for SB management guidelines.
  • Disseminate educational content to enhance physician care for infants with MM.

Main Methods:

  • Systematic literature review of PubMed and Embase (1966-2016).
  • Strict inclusion/exclusion criteria for article selection.
  • Focused review on prenatal closure impact, hydrocephalus, and outcomes.

Main Results:

  • Reviewed hundreds of abstracts across 5 key topics related to SB.
  • Identified 14 studies meeting stringent inclusion criteria.
  • Evaluated evidence on ventriculomegaly and cognitive impairment.

Conclusions:

  • Developed 5 clinical practice recommendations for SB management.
  • Recommendations include 1 Level I, 2 Level II, and 2 Level III evidence-based guidelines.
  • Full guidelines available at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-1.
Abstract

Keywords:
FetalGuidelinesIn uteroMyelomeningocelePostnatalSpina bifidaTethered cord syndrome

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