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

Details

• Alternative Title:
  Dev Med Child Neurol
• Personal Author:
  WORLEY, GORDON ; GREENBERG, RACHEL G ; ROCQUE, BRANDON G ; LIU, TIEBIN ; DICIANNO, BRAD E ; CASTILLO, JONATHAN P ; WARD, ELISABETH A ; WILLIAMS, TONYA R ; BLOUNT, JEFFREY P ; WIENER, JOHN S
• Description:
  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.
  
  
• Subjects:
  Article
• Source:
  Dev Med Child Neurol. 63(11):1294-1301
• Pubmed ID:
  33386749
• Pubmed Central ID:
  PMC8603138
• Document Type:
  Journal Article
• Funding:
  U01 DD001082/DD/NCBDD CDC HHSUnited States/ ; U01 DD001278/DD/NCBDD CDC HHSUnited States/ ; DD000381/DD/NCBDD CDC HHSUnited States/ ; DD000390/DD/NCBDD CDC HHSUnited States/ ; DD000770/DD/NCBDD CDC HHSUnited States/ ; DD000774/DD/NCBDD CDC HHSUnited States/ ; DD000737/DD/NCBDD CDC HHSUnited States/ ; DD000772/DD/NCBDD CDC HHSUnited States/ ; DD000768/DD/NCBDD CDC HHSUnited States/ ; DD000389/DD/NCBDD CDC HHSUnited States/ ; DD000740/DD/NCBDD CDC HHSUnited States/ ; DD000382/DD/NCBDD CDC HHSUnited States/ ; DD000736/DD/NCBDD CDC HHSUnited States/ ; DD000385/DD/NCBDD CDC HHSUnited States/ ; DD000743/DD/NCBDD CDC HHSUnited States/ ; DD000386/DD/NCBDD CDC HHSUnited States/ ; DD000767/DD/NCBDD CDC HHSUnited States/ ; DD000771/DD/NCBDD CDC HHSUnited States/ ; DD000387/DD/NCBDD CDC HHSUnited States/ ; DD001073/DD/NCBDD CDC HHSUnited States/ ; DD000745/DD/NCBDD CDC HHSUnited States/ ; DD000744/DD/NCBDD CDC HHSUnited States/ ; DD001093/DD/NCBDD CDC HHSUnited States/ ; DD000766/DD/NCBDD CDC HHSUnited States/ ; DD001062/DD/NCBDD CDC HHSUnited States/ ; DD001082/DD/NCBDD CDC HHSUnited States/ ; DD001071/DD/NCBDD CDC HHSUnited States/ ; DD000738/DD/NCBDD CDC HHSUnited States/ ; U01 DD001265/DD/NCBDD CDC HHSUnited States/ ; DD000388/DD/NCBDD CDC HHSUnited States/ ; DD001065/DD/NCBDD CDC HHSUnited States/ ; DD001069/DD/NCBDD CDC HHSUnited States/ ; DD001074/DD/NCBDD CDC HHSUnited States/ ; DD001072/DD/NCBDD CDC HHSUnited States/ ; DD000383/DD/NCBDD CDC HHSUnited States/ ; DD000773/DD/NCBDD CDC HHSUnited States/ ; DD001063/DD/NCBDD CDC HHSUnited States/ ; U01 DD001263/DD/NCBDD CDC HHSUnited States/ ; DD000742/DD/NCBDD CDC HHSUnited States/ ; DD001057/DD/NCBDD CDC HHSUnited States/ ; DD001078/DD/NCBDD CDC HHSUnited States/ ; DD001091/DD/NCBDD CDC HHSUnited States/ ; DD000769/DD/NCBDD CDC HHSUnited States/ ; DD001080/DD/NCBDD CDC HHSUnited States/
• Volume:
  63
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:ea4817bac59dcfdd77798665d6be5d1f6d4ced0b72e54716e2e6d58e14070770
• Download URL:
  https://stacks.cdc.gov/view/cdc/111872/cdc_111872_DS1.pdf
• File Type:
  [PDF - 229.51 KB ]