Prenatal Versus Postnatal Surgical Management for Myelomeningocele: A Systematic Review and Comparative Meta-Analysis.
Gabriel Semione, Anna Laura Lima Larcipretti, Leonardo Antônio Silveira Ritossa et al.
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In 30 seconds
This systematic review and comparative meta-analysis assessed prenatal versus postnatal surgical repair for myelomeningocele using 20 comparative studies involving 2862 patients. Prenatal repair was associated with lower risks of hydrocephalus (RR 0.48 [0.41-0.56]), shunt placement (RR 0.50 [0.43-0.58]), and motor dysfunction (RR 0.59 [0.49-0.71]). The analysis found no statistically significant differences in mortality, tethered cord syndrome, or hindbrain herniation. These findings describe comparative associations across included studies rather than establishing that prenatal repair causes better outcomes.
Key findings
- Hydrocephalus risk was lower with prenatal repair (RR 0.48 [0.41-0.56]; I 2 = 5%).
- Shunt placement was less frequent after prenatal repair (RR 0.50 [0.43-0.58]; I 2 = 47%).
- Motor dysfunction was less frequent with prenatal repair (RR 0.59 [0.49-0.71]; I 2 = 0%).
- No statistically significant group differences were found for mortality, tethered cord syndrome, or hindbrain herniation.
Why it matters
The findings highlight differences in important neurological outcomes associated with timing of myelomeningocele repair. In particular, the lower reported risks of hydrocephalus, shunt placement, and motor dysfunction with prenatal repair may inform discussions of management options. The absence of significant differences in other outcomes also underscores that benefits were not uniform across the outcomes assessed.
What to keep in mind
The analysis included comparative cohorts, so the reported associations do not establish causation. Heterogeneity was high for hindbrain herniation (I 2 = 81%).