Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Incidence of Tethered Cord Syndrome in Infants with Myelomeningocele with Prenatal Versus Postnatal Repair

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

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The incidence of spina bifida (SB) is higher in the developing world as compared to the United States because of folic acid deficiency during pregnancy. Advances in technology have made prenatal repair of myelomeningocele (MM) possible. OBJECTIVE: The objective of this guideline was to determine if there is a difference in the rate of development of tethered cord syndrome (TCS) in infants who had prenatal closure compared to infants who had MM repair after birth. METHODS: The Guidelines Task Force developed search terms and strategies to search PubMed and Embase for the relevant literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used. Full text articles were reviewed and, when appropriate, included as evidence. RESULTS: A total of 261 abstracts were reviewed. Fifty-four full-Text articles were selected for further analysis. Three studies met inclusion criteria. CONCLUSION: There was Class II evidence from 1 study and Class III evidence from another 2 studies demonstrating that TCS develops in infants with prenatal MM closure at an equal or higher rate than with postnatal closure. There was an increased risk of development of inclusion cysts in infants who underwent in utero closure. Continued surveillance for TCS and/or the development of inclusion cysts in children with prenatal and postnatal closure of MM is indicated (Level II). Differences between prenatal and postnatal repair with respect to the development of TCS and/or inclusion cysts should be considered alongside other relevant maternal and fetal outcomes when deciding upon a preferred method for MM closure. The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-6.

Original languageEnglish (US)
Article numbernyz266
Pages (from-to)E417-E419
JournalClinical Neurosurgery
Volume85
Issue number3
DOIs
StatePublished - Sep 1 2019

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Meningomyelocele
Spinal Dysraphism
Neural Tube Defects
Guidelines
Incidence
Cysts
Folic Acid Deficiency
Advisory Committees
PubMed
Mothers
Parturition
Technology
Pregnancy

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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

In: Clinical Neurosurgery, Vol. 85, No. 3, nyz266, 01.09.2019, p. E417-E419.

Research output: Contribution to journalArticle

Mazzola, CA, Tyagi, R, Assassi, N, Bauer, DF, Beier, AD, Blount, JP, Durham, SR, Flannery, AM, Klimo, P, McClung-Smith, C, Nikas, DC, Rehring, P & Tamber, MS 2019, 'Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Incidence of Tethered Cord Syndrome in Infants with Myelomeningocele with Prenatal Versus Postnatal Repair', Clinical Neurosurgery, vol. 85, no. 3, nyz266, pp. E417-E419. https://doi.org/10.1093/neuros/nyz266
Mazzola, Catherine A. ; Tyagi, Rachana ; Assassi, Nadege ; Bauer, David F. ; Beier, Alexandra D. ; Blount, Jeffrey P. ; Durham, Susan R. ; Flannery, Ann Marie ; Klimo, Paul ; McClung-Smith, Catherine ; Nikas, Dimitrios C. ; Rehring, Patricia ; Tamber, Mandeep S. / Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Incidence of Tethered Cord Syndrome in Infants with Myelomeningocele with Prenatal Versus Postnatal Repair. In: Clinical Neurosurgery. 2019 ; Vol. 85, No. 3. pp. E417-E419.
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title = "Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Incidence of Tethered Cord Syndrome in Infants with Myelomeningocele with Prenatal Versus Postnatal Repair",
abstract = "BACKGROUND: The incidence of spina bifida (SB) is higher in the developing world as compared to the United States because of folic acid deficiency during pregnancy. Advances in technology have made prenatal repair of myelomeningocele (MM) possible. OBJECTIVE: The objective of this guideline was to determine if there is a difference in the rate of development of tethered cord syndrome (TCS) in infants who had prenatal closure compared to infants who had MM repair after birth. METHODS: The Guidelines Task Force developed search terms and strategies to search PubMed and Embase for the relevant literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used. Full text articles were reviewed and, when appropriate, included as evidence. RESULTS: A total of 261 abstracts were reviewed. Fifty-four full-Text articles were selected for further analysis. Three studies met inclusion criteria. CONCLUSION: There was Class II evidence from 1 study and Class III evidence from another 2 studies demonstrating that TCS develops in infants with prenatal MM closure at an equal or higher rate than with postnatal closure. There was an increased risk of development of inclusion cysts in infants who underwent in utero closure. Continued surveillance for TCS and/or the development of inclusion cysts in children with prenatal and postnatal closure of MM is indicated (Level II). Differences between prenatal and postnatal repair with respect to the development of TCS and/or inclusion cysts should be considered alongside other relevant maternal and fetal outcomes when deciding upon a preferred method for MM closure. The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-6.",
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AU - Tyagi, Rachana

AU - Assassi, Nadege

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AU - Beier, Alexandra D.

AU - Blount, Jeffrey P.

AU - Durham, Susan R.

AU - Flannery, Ann Marie

AU - Klimo, Paul

AU - McClung-Smith, Catherine

AU - Nikas, Dimitrios C.

AU - Rehring, Patricia

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