AANS Neurosurgeon | Volume 27, Number 2, 2018


Effects of Prenatal Myelomeningocele Closure on CSF Shunts

A new analysis of prental myelomeningocele closure regarding the need for placement of a cerebrospinal fluid (CSF) shunt within the first 12 months of life reaffirms previous studies that prenatal repair of a myelomeningocele will result in less need for a shunt at 12-months old. Researchers also learned that prenatal repair can reduce the need for shunt revision in infants who do require shunt placement. The study also showed how patients with extensive hydrocephalus (a common side effect of myelomeningocele) at the time of prenatal evaluation did not have improved outcomes following prenatal surgery. During their analysis of 183 children (91 who were treated prenatally and 92 treated after birth), researchers found that a substantial number of infants met the criteria for shunt placement but did not receive one. Therefore, the researchers redefined criteria from previous studies for shunt placement based on the more overt signs of hydrocephalus that are now used by surgeons to decide when a shunt should be inserted. The researchers also found two prenatal characteristics that had a significant impact on the effectiveness of prenatal surgery: the size of the lateral ventricles within the brain at the time of prenatal screening ultrasonography (19–25 weeks gestational age) and the gestational age at enrollment. Based on their findings, researchers suggested that it may be best to perform prenatal surgery early — when the ventricles are still small. They also stated that fetuses with ventricles smaller than 10 millimeters are the best candidates for prenatal surgery, and noted that this procedure should take place earlier than 20 weeks. To read more about this study, click here.

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