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Selective surgical management of neural tube malformations
Insights
Early surgery for spina bifida cystica improves survival and mobility. While selection enhances continence and intelligence, delaying treatment may not negatively impact cognitive abilities.
Area of Science:
- Pediatric Surgery
- Developmental Pediatrics
- Clinical Outcomes Research
Background:
- Spina bifida cystica is a complex congenital condition requiring surgical intervention.
- Outcomes for early surgical selection versus unselected or delayed treatment remain a critical area of study.
Purpose of the Study:
- To compare the physical characteristics and developmental outcomes of children with spina bifida cystica based on surgical selection and timing.
- To evaluate the impact of early surgical intervention on mortality, mobility, continence, and intelligence.
Main Methods:
- Retrospective review of children with spina bifida cystica born in the 1960s.
- Comparison of three groups: early surgical selection, unselected survivors, and delayed surgical treatment.
- Assessment of physical characteristics, mobility, continence, and intelligence.
Main Results:
- Children selected for early surgery demonstrated significantly lower mortality rates and improved mobility compared to unselected groups.
- Early surgical selection led to better rates of normal fecal and urinary continence (35%) versus none in the unselected group.
- Children treated immediately showed higher intelligence scores, though delayed treatment also resulted in intellectually normal individuals in a fifth of cases.
Conclusions:
- Early surgical selection for spina bifida cystica significantly improves survival and functional outcomes, including continence.
- While immediate treatment correlates with higher intelligence, delaying surgery does not appear to have a substantial negative impact on cognitive ability.
- The findings support the benefits of selective early surgical intervention for spina bifida cystica while acknowledging potential for positive outcomes with delayed treatment.
Abstract:
The physical characteristics of 49 children with spina bifida cystica, survivors of a group subjected to selection for early surgery are compared with 39 children alive from an earlier unselected series, born in the 1960s, and reviewed retrospectively. Sixteen children were also studied in whom the initial decision not to operate had been followed by survival and subsequent treatment. Children selected for initial surgery have a significantly lower mortality than those not selected and their mobility at 5 to 7 years of age is better, although only marginally so compared with the unselected group. Selection does not decrease the need for shunt treatment of the associated hydrocephalus. None of those not initially selected for surgery have normal faecal or urinary continence, whereas 35% of the selected in group have normal continence and urinary tracts. Children treated immediately have significantly higher degrees of intelligence than both the unselectively treated and those whose treatment was delayed but a fifth of the latter group were intellectually normal. There were only small differences in intelligence between children given delayed treatment and those unselectively treated, suggesting that postponing surgery does not necessarily have a deleterious effect on ability.