Myelomeningocele: the evolution of care over the last 50 years
Robin M Bowman1, Ji Yeoun Lee2,3, Jeyul Yang4
1Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago; Neurosurgery Department, Northwestern University, Chicago, IL, USA.
Purpose:
Myelomeningocele (MMC) is one of the representative anomalies in the field of pediatric neurosurgery. During the 50 years of ISPN history, MMC had a tremendous changes in its incidence, clinical management and outcome with advanced understanding of its pathogenesis. We reviewed the changes in MMC during the period.
Methods:
We reviewed the literature review and collected our experiences.
Results:
During the 50 years, major changes happened in many aspects of MMC including incidence, pathoembryogenesis, folate deficiency, prevention, prenatal diagnosis, mode of delivery, treatment policy with ethical considerations, clinical treatment including fetal surgery, latex allergy, retethering, management outcome, multidisciplinary team approach, and socioeconomic and family issues.
Conclusions:
There was a great advance in the management and research of MMC during the 50 years. It is a monumental achievement of pediatric neurosurgeons and colleagues of the related fields.
Insights
Over 50 years, myelomeningocele (MMC) management has significantly advanced in pediatric neurosurgery. Key changes include prevention, prenatal diagnosis, fetal surgery, and multidisciplinary care, improving patient outcomes.
Area of Science:
- Pediatric Neurosurgery
- Developmental Biology
- Public Health
Background:
- Myelomeningocele (MMC) is a significant congenital anomaly impacting pediatric neurosurgery.
- The International Society of Pediatric Neurosurgery (ISPN) has witnessed substantial evolution in understanding and managing MMC over its 50-year history.
Purpose of the Study:
- To review the transformative changes in the incidence, pathogenesis, and clinical management of myelomeningocele (MMC) over the past 50 years.
- To document the advancements in pediatric neurosurgery related to MMC during the ISPN's history.
Main Methods:
- Comprehensive literature review.
- Analysis of clinical experiences and historical data within pediatric neurosurgery.
Main Results:
- Major shifts observed in MMC incidence, pathoembryogenesis, and the role of folate deficiency.
- Significant progress in prevention strategies, prenatal diagnosis, and delivery modes.
- Evolution of treatment policies, including ethical considerations, fetal surgery, latex allergy management, retethering interventions, and multidisciplinary team approaches.
- Improvements noted in management outcomes and attention to socioeconomic and family issues.
Conclusions:
- The last 50 years represent a period of monumental achievement in the management and research of myelomeningocele (MMC).
- Collaborative efforts among pediatric neurosurgeons and related specialists have driven substantial progress in addressing MMC.
