Significant brainstem dysfunction in neonates with myelomeningoceles: a comparison of prenatal versus postnatal closure

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  • 1 Section of Neurosurgery, Children’s Mercy Hospital, Kansas City, Missouri;
  • | 2 Fetal Health Center, Children’s Mercy Hospital, Kansas City, Missouri; and
  • | 3 Department of Neurosurgery, University of Kansas School of Medicine, Kansas City, Kansas
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OBJECTIVE

The purpose of this study was to compare the incidence of significant brainstem dysfunction (SBD) in neonates with myelomeningocele who have been treated with prenatal versus postnatal closure at a single institution.

METHODS

The records and imaging of all children undergoing either prenatal (n = 27) or postnatal (n = 60) closure of myelomeningocele at the authors’ institution from December 2014 through May 2021 were reviewed. SBD, fetal ventricular size, gestational age at fetal imaging and delivery, postnatal ventricular size, need for and type of hydrocephalus treatment, spinal neurological level at birth, anatomical Chiari severity, death, and prenatal or postnatal repair were factors recorded. SBD was defined by need for airway surgery or gastrostomy tube, or endotracheal intubation because of apnea, aspiration, or airway control problems. Comparisons between prenatal and postnatal cohorts and between the cohorts with and without SBD were performed.

RESULTS

SBD occurred in 25% and 0% of neonates who underwent postnatal and prenatal closure, respectively. There were no differences in fetal ventricular size or spinal neurological level between the prenatal and postnatal cohorts or between those with or without SBD. Anatomical severity of the Chiari malformation after birth was worse in the postnatal cohort. Hydrocephalus treatment was required in 70% and 33% of infants who underwent postnatal and prenatal closure, respectively. All three deaths were in the postnatal group from SBD.

CONCLUSIONS

Prenatal closure of myelomeningocele is associated with a significant reduction in SBD.

ABBREVIATIONS

ETV/CPC = endoscopic third ventriculostomy and choroid plexus coagulation; MOMS = Management of Myelomeningocele Study; SBD = significant brainstem dysfunction; VPS = ventriculoperitoneal shunt.

Diagram from Behbahani et al. (pp 488–496).

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