Neurosurgical procedures for children with myelomeningocele after fetal or postnatal surgery: a comparative effectiveness study.
Gordon Worley, Rachel G Greenberg, Brandon G Rocque and 7 others
PMID 33386749WHAT IT FOUND
Fetal surgery for myelomeningocele was associated with fewer CSF diversion procedures and fewer Chiari decompressions than postnatal surgery.
Shunt revisions and tethered cord releases did not differ.
Key findings
01In adjusted analyses, fetal surgery was associated with a significantly lower risk of CSF diversion and Chiari decompression.
02The frequencies of tethered cord release and shunt revision in shunted patients did not differ significantly between cohorts.
03Median age at first CSF diversion was 91 days in the fetal surgery cohort and 0 days in the postnatal surgery cohort.
STILL TO COME
How it was doneWhat they found
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What it does not show
The registry did not independently validate the reliability of the collected data. Motor level cannot be assessed as reliably before 5 years old as after 5 years old. The registry did not record prenatal data except whether fetal surgery occurred, so postnatal patients could not be matched on fetal surgery exclusion criteria. The postnatal cohort likely included more patients who would have been excluded from fetal surgery, such as patients without fetal hindbrain herniation, which may have reduced the observed difference. Results may not apply to patients not cared for in a multidisciplinary spina bifida clinic. The study compared neurosurgical procedures, not cognition, walking, or bladder function.
Declared interests
No funding or conflict-of-interest declaration is included in the supplied text.
The easy way to misread this
Do not read the lower CSF diversion and Chiari decompression results as evidence that fetal surgery improves walking, thinking, or bladder function. The study compared neurosurgical procedures, not those outcomes.