Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Incidence of Shunt-Dependent Hydrocephalus in Infants with Myelomeningocele after Prenatal Versus Postnatal Repair

Mandeep S. Tamber, Ann Marie Flannery, Catherine McClung-Smith, Nadege Assassi, David F. Bauer, Alexandra D. Beier, Jeffrey P. Blount, Susan R. Durham, Paul Klimo, Dimitrios C. Nikas, Patricia Rehring, Rachana Tyagi, Catherine A. Mazzola

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Myelomeningocele (MM) is a condition that is responsible for considerable morbidity in the pediatric population. A significant proportion of the morbidity related to MM is attributable to hydrocephalus and the surgical management thereof. Postnatal repair remains the most common form of treatment; however, increased rates of prenatal diagnosis, advances in fetal surgery, and a hypothesis that neural injury continues in utero until the MM defect is repaired have led to the development and evaluation of prenatal surgery as a means to improve outcomes in afflicted infants. OBJECTIVE: The objective of this guideline is to systematically evaluate the literature to determine whether there is a difference in the proportion of patients who develop shunt-dependent hydrocephalus in infants who underwent prenatal MM repair compared to infants who had postnatal repair. METHODS: The Guidelines Task Force developed search terms and strategies used to search PubMed and Embase for relevant literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used to screen abstracts and to develop a list of relevant articles for full-Text review. Full-Text articles were then reviewed, and when appropriate, included as evidence. RESULTS: A total of 87 abstracts were identified and reviewed by 3 independent reviewers. Thirty-nine full-Text articles were selected for analysis. Three studies met selection criteria and were included in the evidence table. CONCLUSION: Class I evidence from 1 study and class III evidence from 2 studies suggest that, in comparison to postnatal repair, prenatal surgery for MM reduces the risk of developing shunt-dependent hydrocephalus. Therefore, prenatal repair of MM is recommended for those fetuses who meet specific criteria for prenatal surgery to reduce the risk of developing shunt-dependent hydrocephalus (level I). Differences between prenatal and postnatal repair with respect to the requirement for permanent cerebrospinal fluid diversion should be considered alongside other relevant maternal and fetal factors when deciding upon a preferred method of MM closure. âThe full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-2.

Original languageEnglish (US)
Article numbernyz262
Pages (from-to)E405-E408
JournalClinical Neurosurgery
Volume85
Issue number3
DOIs
StatePublished - Sep 1 2019

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Meningomyelocele
Spinal Dysraphism
Hydrocephalus
Guidelines
Incidence
Morbidity
Advisory Committees
Prenatal Diagnosis
PubMed
Patient Selection
Cerebrospinal Fluid
Fetus
Mothers
Pediatrics
Wounds and Injuries
Population

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Incidence of Shunt-Dependent Hydrocephalus in Infants with Myelomeningocele after Prenatal Versus Postnatal Repair. / Tamber, Mandeep S.; Flannery, Ann Marie; McClung-Smith, Catherine; Assassi, Nadege; Bauer, David F.; Beier, Alexandra D.; Blount, Jeffrey P.; Durham, Susan R.; Klimo, Paul; Nikas, Dimitrios C.; Rehring, Patricia; Tyagi, Rachana; Mazzola, Catherine A.

In: Clinical Neurosurgery, Vol. 85, No. 3, nyz262, 01.09.2019, p. E405-E408.

Research output: Contribution to journalArticle

Tamber, MS, Flannery, AM, McClung-Smith, C, Assassi, N, Bauer, DF, Beier, AD, Blount, JP, Durham, SR, Klimo, P, Nikas, DC, Rehring, P, Tyagi, R & Mazzola, CA 2019, 'Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Incidence of Shunt-Dependent Hydrocephalus in Infants with Myelomeningocele after Prenatal Versus Postnatal Repair', Clinical Neurosurgery, vol. 85, no. 3, nyz262, pp. E405-E408. https://doi.org/10.1093/neuros/nyz262
Tamber, Mandeep S. ; Flannery, Ann Marie ; McClung-Smith, Catherine ; Assassi, Nadege ; Bauer, David F. ; Beier, Alexandra D. ; Blount, Jeffrey P. ; Durham, Susan R. ; Klimo, Paul ; Nikas, Dimitrios C. ; Rehring, Patricia ; Tyagi, Rachana ; Mazzola, Catherine A. / Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Incidence of Shunt-Dependent Hydrocephalus in Infants with Myelomeningocele after Prenatal Versus Postnatal Repair. In: Clinical Neurosurgery. 2019 ; Vol. 85, No. 3. pp. E405-E408.
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abstract = "BACKGROUND: Myelomeningocele (MM) is a condition that is responsible for considerable morbidity in the pediatric population. A significant proportion of the morbidity related to MM is attributable to hydrocephalus and the surgical management thereof. Postnatal repair remains the most common form of treatment; however, increased rates of prenatal diagnosis, advances in fetal surgery, and a hypothesis that neural injury continues in utero until the MM defect is repaired have led to the development and evaluation of prenatal surgery as a means to improve outcomes in afflicted infants. OBJECTIVE: The objective of this guideline is to systematically evaluate the literature to determine whether there is a difference in the proportion of patients who develop shunt-dependent hydrocephalus in infants who underwent prenatal MM repair compared to infants who had postnatal repair. METHODS: The Guidelines Task Force developed search terms and strategies used to search PubMed and Embase for relevant literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used to screen abstracts and to develop a list of relevant articles for full-Text review. Full-Text articles were then reviewed, and when appropriate, included as evidence. RESULTS: A total of 87 abstracts were identified and reviewed by 3 independent reviewers. Thirty-nine full-Text articles were selected for analysis. Three studies met selection criteria and were included in the evidence table. CONCLUSION: Class I evidence from 1 study and class III evidence from 2 studies suggest that, in comparison to postnatal repair, prenatal surgery for MM reduces the risk of developing shunt-dependent hydrocephalus. Therefore, prenatal repair of MM is recommended for those fetuses who meet specific criteria for prenatal surgery to reduce the risk of developing shunt-dependent hydrocephalus (level I). Differences between prenatal and postnatal repair with respect to the requirement for permanent cerebrospinal fluid diversion should be considered alongside other relevant maternal and fetal factors when deciding upon a preferred method of MM closure. {\^a}The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-2.",
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AU - Flannery, Ann Marie

AU - McClung-Smith, Catherine

AU - Assassi, Nadege

AU - Bauer, David F.

AU - Beier, Alexandra D.

AU - Blount, Jeffrey P.

AU - Durham, Susan R.

AU - Klimo, Paul

AU - Nikas, Dimitrios C.

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