Neurosurgery guidelines for the care of people with spina bifida.
Jeffrey P Blount, Robin Bowman, Mark S Dias and 3 others
PMID 33325414WHAT IT FOUND
Most neurosurgical care for spina bifida relies on expert consensus rather than high-quality evidence.
Therapists should monitor for shunt failure and tethered cord signs like pain or lost milestones, as clinical decline can occur even when brain imaging looks stable.
Key findings
01The majority of neurosurgical guidelines for spina bifida are based on clinical consensus rather than high-level evidence.
02Ventricular size on imaging is sometimes insufficient for assessing hydrocephalus, meaning clinical symptoms like deterioration are more meaningful indicators of shunt failure.
03In utero closure of myelomeningocele reduces the need for shunts and improves motor function, but carries higher risks of premature delivery and maternal complications.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Most recommendations are based on expert consensus rather than high-quality randomized controlled trials. The guidelines do not report new patient data or outcomes from a specific study. Long-term durability of benefits from in utero closure remains uncertain due to limited longitudinal studies.
Declared interests
The original guidelines arose from a meeting jointly sponsored by the Centers for Disease Control and Prevention, the National Institute of Child Health and Human Development, the Agency for Healthcare Research and Quality, the National Institute of Health Office of Rare Disease, and the Spina Bifida Association.
The easy way to misread this
Do not assume a patient is stable if their brain imaging looks normal. The guidelines state that clinical deterioration and symptoms of shunt failure can occur without changes in ventricular size on CT or MRI.