Prenatal Versus Postnatal Surgical Management for Myelomeningocele: A Systematic Review and Comparative Meta-Analysis

Myelomeningocele (MMC) is a neural tube defect and 1 of 3 forms of spina bifida. The management of this disease is a matter of discussion in the literature. To attempt to alleviate this gap in the current literature, the authors conducted a systematic review and comparative meta-analysis on this topic.

Fulfilling Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the authors systematically searched the Embase, PubMed, and Web of Science databases to identify English articles reporting comparative cohorts of more than 4 patients with MMC being submitted for either prenatal or postnatal repair. Risk ratio (RR) with 95% CI was used to measure effects in comparative analysis with a random-effect model applied. Sensitivity analysis was used to explore cases of high heterogeneity.

From 885 studies initially found, 20 studies with 2862 patients were included in the analysis. Of these patients 1587 were submitted to postnatal repair and 1275 to prenatal repair. No statistical difference between groups were found in mortality (RR 2.00 [0.71-5.63]; I 2 = 0%), tethered cord syndrome (RR 1.40 [0.89-2.19]; I 2 = 29%), and hindbrain herniation (RR 0.88 [0.74-1.04]; I 2 = 81%). Hydrocephalus developed in 557 patients, significantly favoring prenatal repair 0.48 (RR 0.48 [0.41-0.56]; I 2 = 5%). Shunt placement occurred in 360 patients, significantly favoring prenatal repair (RR 0.50 [0.43-0.58]; I 2 = 47%). Motor dysfunctions happened in 197 patients significantly favoring prenatal repair 0.59 (RR 0.59 [0.49-0.71]; I 2 = 0%).

Prenatal MMC repair was associated with a smaller risk of hydrocephalus development, shunt placement, and motor dysfunctions.