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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Closure of Myelomeningocele

Alexandra D Beier1, Dimitrios C Nikas2, Nadege Assassi3

  • 1Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida.

Neurosurgery
|August 17, 2019
PubMed
Abstract

Insights

Closing myelomeningocele (MM) within 48 hours lacks sufficient evidence to decrease infection risk. Current guidelines suggest antibiotics if surgery is delayed beyond 48 hours.

Area of Science:

  • Medical Guidelines
  • Surgical Outcomes
  • Pediatric Neurosurgery

Background:

  • Myelomeningocele (MM) closure timing is debated, with older studies suggesting increased infection risks after 48 hours.
  • Variability exists in the literature regarding the optimal timeframe for MM repair.

Purpose of the Study:

  • To determine if closing myelomeningocele (MM) within 48 hours reduces the risk of wound infection or ventriculitis.
  • To provide evidence-based recommendations for MM closure timing.

Main Methods:

  • A systematic literature search was conducted using PubMed and Embase (1966-2016).
  • Inclusion/exclusion criteria were applied to screen abstracts and full-text articles.
  • The Guidelines Task Force evaluated and assigned the class of evidence to included studies.

Main Results:

  • Only 4 out of 31 reviewed full-text articles met the inclusion criteria.
  • One Class III study found insufficient evidence that closing MM within 48 hours decreases wound infection or ventriculitis risk.
  • One Class III study indicated a general increase in postoperative infection after 48 hours, not specific to wound infection or ventriculitis.

Conclusions:

  • There is insufficient evidence to support closing myelomeningocele (MM) within 48 hours to decrease wound infection or ventriculitis.
  • Guidelines suggest administering antibiotics if MM surgery is delayed beyond 48 hours.
Keywords:
FetalInfectionMeningitisMyelomeningoceleSurgeryVentriculitis

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