Format

Send to

Choose Destination
Neurosurg Focus. 2019 Oct 1;47(4):E8. doi: 10.3171/2019.7.FOCUS19406.

Pediatric neurosurgeons' views regarding prenatal surgery for myelomeningocele and the management of hydrocephalus: a national survey.

Author information

1
1Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
2
2Department of Surgery, Mayo Clinic, Rochester, Minnesota.
3
3University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Pennsylvania.
4
4The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Pennsylvania.
5
5Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri; and.
6
6Division of Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania.

Abstract

OBJECTIVE:

The Management of Myelomeningocele Study (MOMS) compared prenatal with postnatal surgery for myelomeningocele (MMC). The present study sought to determine how MOMS influenced the clinical recommendations of pediatric neurosurgeons, how surgeons' risk tolerance affected their views, how their views compare to those of their colleagues in other specialties, and how their management of hydrocephalus compares to the guidelines used in the MOMS trial.

METHODS:

A cross-sectional survey was sent to all 154 pediatric neurosurgeons in the American Society of Pediatric Neurosurgeons. The effect of surgeons' risk tolerance on opinions and counseling of prenatal closure was determined by using ordered logistic regression.

RESULTS:

Compared to postnatal closure, 71% of responding pediatric neurosurgeons viewed prenatal closure as either "very favorable" or "somewhat favorable," and 51% reported being more likely to recommend prenatal surgery in light of MOMS. Compared to pediatric surgeons, neonatologists, and maternal-fetal medicine specialists, pediatric neurosurgeons viewed prenatal MMC repair less favorably (p < 0.001). Responders who believed the surgical risks were high were less likely to view prenatal surgery favorably and were also less likely to recommend prenatal surgery (p < 0.001). The management of hydrocephalus was variable, with 60% of responders using endoscopic third ventriculostomy in addition to ventriculoperitoneal shunts.

CONCLUSIONS:

The majority of pediatric neurosurgeons have a favorable view of prenatal surgery for MMC following MOMS, although less so than in other specialties. The reported acceptability of surgical risks was strongly predictive of prenatal counseling. Variation in the management of hydrocephalus may impact outcomes following prenatal closure.

KEYWORDS:

ASPN = American Society of Pediatric Neurosurgeons; ETV = endoscopic third ventriculostomy; MFM = maternal-fetal medicine; MMC = myelomeningocele; MOMS = The Management of Myelomeningocele Study; MOMS trial; The Management of Myelomeningocele Study; VP = ventriculoperitoneal; fetal surgery; hydrocephalus; myelomeningocele; spina bifida

PMID:
31574481
DOI:
10.3171/2019.7.FOCUS19406

Supplemental Content

Full text links

Icon for Sheridan PubFactory
Loading ...
Support Center