Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Pediatric Myelomeningocele: Executive Summary.

Catherine A Mazzola, Nadege Assassi, Lissa C Baird, 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, Rachana Tyagi

Journal: Neurosurgery 2020;85(3):299-301

PMID: 31418038

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Abstract

BACKGROUND

The incidence of spina bifida (SB) in the developing world is higher than in the United States because of malnutrition and folic acid deficiency during pregnancy. Advances in technology have made prenatal repair of myelomeningocele (MM) possible.

OBJECTIVE

The objective of the guidelines are, (1) To create clinical recommendations for best practices, based on a systematic review and analysis of available literature, (2) to obtain multi-disciplinary endorsement of these guidelines from relevant organizations, and (3) to disseminate the educational content to physicians to improve the care of infants with MM.

METHODS

The Guidelines Task Force developed search terms and strategies used to search PubMed and Embase for 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.

RESULTS

Guidelines authors aimed to systematically review the literature and make evidence based recommendations about the timing of closure after birth, hydrocephalus, the impact of prenatal closure, and the effect of prenatal closure on ambulation ability and tethered spinal cord. Evidence concerning persistent ventriculomegaly and cognitive impairment was also evaluated. Hundreds of abstracts were identified and reviewed for each of the 5 topics. A total of 14 studies met stringent inclusion criteria.

CONCLUSION

Based on a comprehensive systematic review, a total of 5 clinical practice recommendations were developed, with 1 Level I, 2 Level II and 2 Level III recommendations.The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-1.

Address: Goryeb Children's Hospital, Morristown, New Jersey.; Department of Neurological Surgery, Rutgers, Newark, New Jersey.; Department of Surgery, Division of Neurosurgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey.; Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon.; Department of Surgery, Division of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.; Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida.; Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama.; Division of Neurosurgery, University of Vermont, Burlington, Vermont.; Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana.; Semmes Murphey, Memphis, Tennessee.; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.; Le Bonheur Children's Hospital, Memphis, Tennessee.; Department of Neurological Surgery, Palmetto Health USC Medical Group, Columbia, South Carolina.; Division of Pediatric Neurosurgery, Advocate Children's Hospital, Oak Lawn, Illinois.; Congress of Neurological Surgeons, Schaumburg, Illinois.; Division of Pediatric Neurosurgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada.; Department of Neurosurgery, Mercer University Medical School, Macon, Georgia.

DOI: 10.1093/neuros/nyz261

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MeSH Terms: Child, Female, Humans, Infant, Meningomyelocele, Pregnancy, United States