Differences in brain development and need for CSF diversion based on MMC level: Comparison between prenatal and...

Area of Science:

• Neuroscience
• Developmental Biology
• Pediatric Surgery

Background:

• Myelomeningocele (MMC) is a complex birth defect affecting spinal cord development.
• Understanding how MMC lesion level influences early brain development and hydrocephalus is crucial for optimizing treatment strategies.

Purpose of the Study:

• To investigate the impact of myelomeningocele (MMC) lesion level on early brain development.
• To determine differences in cerebrospinal fluid (CSF) diversion needs based on MMC level and timing of surgical repair (prenatal vs. postnatal).

Main Methods:

• Retrospective analysis of patients with lumbosacral MMC treated between 2016-2021.
• Comparison of brain imaging characteristics and CSF diversion rates between higher (L1-L3) and lower (L4-sacrum) MMC lesion levels.
• Stratification of analyses by prenatal and postnatal surgical repair cohorts.

Main Results:

• Higher MMC lesion levels (L1-L3) were associated with larger prenatal third ventricular and postnatal frontal horn diameters compared to lower levels (L4-sacrum).
• Increased massa intermedia size was observed with higher MMC levels in the postnatal repair group.
• MMC level was not linked to CSF diversion in the overall or prenatal repair groups, but higher MMC levels correlated with increased CSF diversion need in the postnatal repair cohort.

Conclusions:

• Significant differences in ventricular size exist based on MMC lesion level.
• Prenatal MMC repair may mitigate hydrocephalus risk, particularly in cases with higher lesion levels.
• Higher MMC levels are associated with increased CSF diversion needs in postnatally repaired patients, but not in prenatally repaired ones.