TO THE READERSHIP: An error appeared in the article by Tulipan et al. (Tulipan N, Wellons JC III, Thom EA, et al. Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement. J Neurosurg Pediatr. 2015;16[6]:613-620).
Credit for copyrighted text was not included in the footnotes of Tables 2 and 3 for material previously published in The New England Journal of Medicine. The tables appear on the following pages with the proper credit given in the footnotes.
Primary outcome and related outcomes*
| Variable | Prenatal Surgery (n = 91) | Postnatal Surgery (n = 92) | Relative Risk (CI) | p Value |
|---|---|---|---|---|
| Primary outcome | 66 (72.5) | 90 (97.8) | 0.74 (96.2% CI 0.65–0.85) | <0.0001 |
| Death before shunt criteria could be evaluated | 2 (2.2) | 0 (0.0) | ||
| Met criteria, shunt placed | 40 (44.0) | 73 (79.3) | ||
| Did not meet criteria, shunt placed | 0 (0.0) | 4 (4.3) | ||
| Met criteria, no shunt placed | 24 (26.4) | 13 (14.1) | ||
| Did not meet criteria, no shunt placed | 25 (27.5) | 2 (2.2) | ||
| Specific criteria met† | <0.0001 | |||
| None | 27 (29.7) | 6 (6.5) | ||
| Criterion 1a, c, or d only | 36 (39.6) | 20 (21.7) | ||
| Criterion 1b & one or more of 1a, 1c, 1d only | 21 (23.1) | 35 (38.0) | ||
| Criterion 2 (w/ or w/o Criterion 1) | 0 (0.0) | 2 (2.2) | ||
| Criterion 3 (w/ or w/o Criterion 1 or 2) | 6 (6.6) | 6 (6.5) | ||
| Criterion 4 (w/ or w/o Criteria 1–3) | 1 (1.1) | 23 (25.0) | ||
| Revised composite outcome | 45 (49.5) | 80 (87.0) | <0.0001 | |
| Death before shunt criteria could be evaluated | 2 (2.2) | 0 (0.0) | ||
| Met criteria, shunt placed | 25 (27.5) | 63 (68.5) | ||
| Shunt placed w/o meeting criteria | 15 (16.5) | 14 (15.2) | ||
| Met criteria, no shunt placed | 3 (3.3) | 3 (3.3) | ||
| Did not meet criteria, no shunt placed | 46 (50.5) | 12 (13.0) | ||
| Shunt & revision | 14 (15.4) | 37 (40.2) | 0.38 (95% CI 0.22–0.66) | <0.001 |
| No. of revisions‡ | ||||
| 0 | 26 (65.0) | 40 (52.0) | ||
| 1 | 7 (17.5) | 21 (27.3) | ||
| ≥2 | 7 (17.5) | 16 (20.8) |
Data presented as number (%).
Criterion 1: at least 2 of the following:
a) an increase in the greatest occipital-frontal circumference adjusted for gestational age defined as crossing percentiles (if a plateau was reached this did not qualify);
b) bulging fontanelle or split sutures or sunsetting sign;
c) increasing hydrocephalus on consecutive imaging studies determined by increase in ratio of biventricular diameter to biparietal diameter according to the method of O’Hayon et al.; or
d) head circumference > 95th percentile for gestational age.
Of those who had shunts placed.
Subgroup analyses for shunt placement and outcome with revised criteria
| Variable | Shunt Placement | Revised Composite Outcome* | ||||
|---|---|---|---|---|---|---|
| Prenatal Surgery (n = 91) | Postnatal Surgery (n = 92) | p Value† | Prenatal Surgery (n = 91) | Postnatal Surgery (n = 92) | p Value† | |
| Lesion level | 0.19 | 0.30 | ||||
| T1–L2 | 11/29 (37.9) | 15/16 (93.8) | 15/29 (51.7) | 16/16 (100) | ||
| L3–S1 | 29/62 (46.8) | 62/76 (81.6) | 30/62 (48.4) | 64/76 (84.2) | ||
| Gestational age at randomization in wks | 0.03‡ | 0.01‡ | ||||
| ≤23 | 16/51 (31.4) | 37/43 (86.1) | 18/51 (35.3) | 39/43 (90.7) | ||
| ≥24 | 24/40 (60.0) | 40/49 (81.6) | 27/40 (67.5) | 41/49 (83.7) | ||
| Ventricle size in mm | 0.01‡ | 0.007‡ | ||||
| <10 | 6/30 (20.0) | 27/34 (79.4) | 6/30 (20.0) | 28/34 (82.4) | ||
| 10 up to 15 | 19/42 (45.2) | 43/50 (86.0) | 22/42 (52.4) | 45/50 (90.0) | ||
| ≥15 | 15/19 (79.0) | 7/8 (87.5) | 17/19 (89.5) | 7/8 (87.5) | ||
| Hindbrain herniation | 0.53 | 0.49 | ||||
| Mild/moderate | 27/64 (42.2) | 56/69 (81.2) | 28/64 (43.8) | 58/69 (84.1) | ||
| Severe | 13/27 (48.2) | 21/23 (91.3) | 17/27 (63.0) | 22/23 (95.7) | ||
Revised composite outcome is defined as follows:
a) increase in the greatest occipital-frontal circumference adjusted for gestational age defined as crossing percentiles (if a plateau was reached this did not qualify);
c) increasing hydrocephalus on consecutive imaging studies determined by increase in ratio of biventricular diameter to biparietal diameter according to the method of O’Hayon et al.; or
d) head circumference > 95th percentile for gestational age.
p value for interaction between factor and surgery group by logistic regression adjusting for sex and lesion level.
Ventricle size and gestational age are included as continuous variables in the model.
The article has been corrected online as of November 4, 2022.
