Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Management of Patients With Myelomeningocele: Whether Prenatal or Postnatal Closure Affects Future Ambulatory Status
| Autor: | Catherine A. Mazzola, Patricia Rehring, Susan R. Durham, Dimitrios C Nikas, Ann Marie Flannery, Alexandra D Beier, David F Bauer, Mandeep S. Tamber, Jeffrey P. Blount, Paul Klimo, Nadege Assassi, Catherine McClung-Smith, Rachana Tyagi |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Pediatrics medicine.medical_specialty Evidence-based practice Meningomyelocele Prenatal care Neurosurgical Procedures law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Pregnancy medicine Humans Closure (psychology) Mobility Limitation Fetal Therapies Evidence-Based Medicine Neural tube defect Spina bifida business.industry Infant Retrospective cohort study Guideline medicine.disease 030220 oncology & carcinogenesis Surgery Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Neurosurgery. 85(3) |
| ISSN: | 1524-4040 |
| Popis: | Background Myelomeningocele (MM) is an open neural tube defect treated by pediatric neurosurgeons with prenatal or postnatal closure. Objective The objective of this systematic review was to answer the question: What is the evidence for the effectiveness of prenatal vs postnatal closure of MM regarding short and long-term ambulatory status? Treatment recommendations were provided based on the available evidence. Methods The National Library of Medicine PubMed database and Embase were queried using MeSH headings and keywords relevant to ambulatory status after prenatal or postnatal closure of MM. Abstracts were reviewed to identify which studies met the inclusion criteria. An evidence table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). Results One randomized controlled trial (Class II) and 3 retrospective cohort studies (Class III) were included as evidence. Initial ambulatory status depended on anatomic level of the neural tube defect. In the short term, prenatal closure may improve ambulatory status compared to postnatal closure. Spinal cord tethering or dermoid inclusion cyst has been associated with neurologic deterioration in infants closed in utero and after birth. Ambulation may cease in both groups over time. No long-term studies evaluated whether there is a difference in the ability to ambulate upon reaching adulthood. Conclusion Prenatal closure of MM may improve ambulatory status in the short term (Level II). Spinal cord tethering in both groups caused deterioration in the ability to walk. Evaluation and treatment of spinal cord tethering may help maintain ambulatory status (Level III). No studies evaluate whether prenatal or postnatal repair provides improved ability to ambulate upon reaching adulthood.The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-3. |
| Databáze: | OpenAIRE |
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