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Neurosurgical procedures for children with myelomeningocele after fetal or postnatal surgery: a comparative effectiveness study.

Publication ,  Journal Article
Worley, G; Greenberg, RG; Rocque, BG; Liu, T; Dicianno, BE; Castillo, JP; Ward, EA; Williams, TR; Blount, JP; Wiener, JS
Published in: Dev Med Child Neurol
November 2021

AIM: To compare the frequencies of neurosurgical procedures to treat comorbid conditions of myelomeningocele in patients who underwent fetal surgery versus postnatal surgery for closure of the placode. METHOD: By utilizing the National Spina Bifida Patient Registry in a comparative effectiveness study, 298 fetal surgery patients were matched by birthdate (±3mo) and spina bifida clinic site with one to three postnatal surgery patients (n=648). Histories were obtained by record review on enrollment and yearly subsequently. Multivariable Poisson regression was used to compare frequencies of procedures between cohorts, with adjustments for sex, ethnicity, insurance status, spinal segmental level of motor function, age at last visit recorded in the Registry, and, for shunt revision in shunted patients, age at cerebrospinal fluid (CSF) diversion. RESULTS: The median age at last visit was 4 years. In fully adjusted analyses in patients aged at least 12 months old, fetal surgery was associated with decreased frequency of CSF diversion for hydrocephalus by ventriculoperitoneal shunt insertion or endoscopic third ventriculostomy compared with postnatal surgery (46% vs 79%; incidence rate ratio=0.61; 95% confidence interval [CI] 0.53-0.71; p<0.01). Over all ages, fetal surgery was associated with decreased frequency of Chiari decompression for brainstem dysfunction (3% vs 7%; incidence rate ratio=0.41; 95% CI 0.19-0.88; p=0.02). Also over all ages, differences were not significant in frequencies of shunt revision in shunted patients (53% vs 55%; incidence rate ratio=0.87; 95% CI 0.69-1.11; p=0.27), nor tethered cord release for acquired spinal cord dysfunction (18% vs 16%; incidence rate ratio=1.11; 95% CI 0.84-1.47; p=0.46). INTERPRETATION: Even with the variations inherent in clinical practice, fetal surgery was associated with lower frequencies of CSF diversion and of Chiari decompression, independent of covariates. What this paper adds Fetal surgery was associated with lower frequencies of cerebrospinal fluid diversion and decompression of Chiari II malformation than postnatal surgery. Frequencies of ventriculoperitoneal shunt revision and tethered cord release were not significantly different between cohorts.

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Published In

Dev Med Child Neurol

DOI

EISSN

1469-8749

Publication Date

November 2021

Volume

63

Issue

11

Start / End Page

1294 / 1301

Location

England

Related Subject Headings

  • Ventriculoperitoneal Shunt
  • Treatment Outcome
  • Spinal Dysraphism
  • Pediatrics
  • Neurosurgical Procedures
  • Meningomyelocele
  • Male
  • Infant
  • Hydrocephalus
  • Humans
 

Citation

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Worley, G., Greenberg, R. G., Rocque, B. G., Liu, T., Dicianno, B. E., Castillo, J. P., … Wiener, J. S. (2021). Neurosurgical procedures for children with myelomeningocele after fetal or postnatal surgery: a comparative effectiveness study. Dev Med Child Neurol, 63(11), 1294–1301. https://doi.org/10.1111/dmcn.14792
Worley, Gordon, Rachel G. Greenberg, Brandon G. Rocque, Tiebin Liu, Brad E. Dicianno, Jonathan P. Castillo, Elisabeth A. Ward, Tonya R. Williams, Jeffrey P. Blount, and John S. Wiener. “Neurosurgical procedures for children with myelomeningocele after fetal or postnatal surgery: a comparative effectiveness study.Dev Med Child Neurol 63, no. 11 (November 2021): 1294–1301. https://doi.org/10.1111/dmcn.14792.
Worley G, Greenberg RG, Rocque BG, Liu T, Dicianno BE, Castillo JP, et al. Neurosurgical procedures for children with myelomeningocele after fetal or postnatal surgery: a comparative effectiveness study. Dev Med Child Neurol. 2021 Nov;63(11):1294–301.
Worley, Gordon, et al. “Neurosurgical procedures for children with myelomeningocele after fetal or postnatal surgery: a comparative effectiveness study.Dev Med Child Neurol, vol. 63, no. 11, Nov. 2021, pp. 1294–301. Pubmed, doi:10.1111/dmcn.14792.
Worley G, Greenberg RG, Rocque BG, Liu T, Dicianno BE, Castillo JP, Ward EA, Williams TR, Blount JP, Wiener JS. Neurosurgical procedures for children with myelomeningocele after fetal or postnatal surgery: a comparative effectiveness study. Dev Med Child Neurol. 2021 Nov;63(11):1294–1301.
Journal cover image

Published In

Dev Med Child Neurol

DOI

EISSN

1469-8749

Publication Date

November 2021

Volume

63

Issue

11

Start / End Page

1294 / 1301

Location

England

Related Subject Headings

  • Ventriculoperitoneal Shunt
  • Treatment Outcome
  • Spinal Dysraphism
  • Pediatrics
  • Neurosurgical Procedures
  • Meningomyelocele
  • Male
  • Infant
  • Hydrocephalus
  • Humans