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

Journal: Neurosurgery 2020;85(3):E417-E419

PMID: 31418037

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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.

Address: Goryeb Children's Hospital, Morristown, New Jersey.; Rutgers Department of Neurological Surgery, Newark, New Jersey.; Department of Neurosurgery, Mercer University Medical School, Macon, Georgia.; Department of Surgery, Division of Neurosurgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey.; 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 Medical Center, 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.

DOI: 10.1093/neuros/nyz266

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https://medlineplus.gov/spinabifida.html

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MeSH Terms: Child, Evidence-Based Medicine, Female, Fetal Therapies, Humans, Incidence, Infant, Meningomyelocele, Neurosurgical Procedures, Pregnancy, Spinal Dysraphism