Pediatric Neurosurgeons Perspective on 2019 Congress of Neurological Surgeons Guidelines on Myelomeningocele

In 2019, the Congress of Neurological Surgeons published clinical practice guidelines for the management of myelomeningocele (MMC), which were informed by Level I evidence from the Management of Myelomeningocele Study trial and aimed to optimize clinical outcomes, particularly regarding prenatal vs postnatal repair. This study evaluates the perceived impact of these guidelines on the pediatric neurosurgical community. A cross-sectional survey was distributed to 700 members of the pediatric neurosurgery community, with 98 responses analyzed. The survey addressed practice patterns, familiarity with the guidelines, and barriers to guideline adherence. Among centers with higher volumes of MMC repairs, there was a reported increase in referrals for prenatal repair, with 25% of domestic and 5% of international respondents offering prenatal repair postguidelines. However, prenatal repair remains limited, particularly in lower-volume and international centers. Barriers such as insufficient training, lack of fetal surgery programs, and limited institutional resources were frequently cited. Regional differences in perceptions regarding ventriculomegaly and tethered cord syndrome further highlight the variability in guideline interpretation. Notably, 71% of international respondents believed persistent ventriculomegaly negatively affects neurocognition, compared with only 30% of domestic respondents. While the guidelines have influenced clinical practices, their implementation remains uneven. The findings underscore the influence of institutional capacity, volume of practice, and regional differences on guideline adoption. Although the 2019 Congress of Neurological Surgeons guidelines have made strides in improving MMC care, continued efforts are necessary to address these barriers, especially in resource-limited settings. Collaboration among academic institutions, policymakers, and healthcare providers is critical to enhancing global implementation of evidence-based practices for myelomeningocele management. Further research is needed to refine practices and standardize outcome measures.