scholarly journals Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Incidence of Tethered Cord Syndrome in Infants With Myelomeningocele With Prenatal Versus Postnatal Repair

Neurosurgery ◽  
2019 ◽  
Vol 85 (3) ◽  
pp. E417-E419 ◽  
Author(s):  
Catherine A Mazzola ◽  
Rachana Tyagi ◽  
Nadege Assassi ◽  
David F Bauer ◽  
Alexandra D Beier ◽  
...  
Keyword(s):  
Spina Bifida ◽  
Full Text ◽  
Task Force ◽  
Relevant Literature ◽  
Tethered Cord ◽  
The United States ◽  
Tethered Cord Syndrome ◽  
Folic Acid Deficiency ◽  
Increased Risk ◽  
Postnatal Closure

Abstract BACKGROUND The incidence of spina bifida (SB) is higher in the developing world as compared to the United States because of folic acid deficiency during pregnancy. Advances in technology have made prenatal repair of myelomeningocele (MM) possible. OBJECTIVE The objective of this guideline was to determine if there is a difference in the rate of development of tethered cord syndrome (TCS) in infants who had prenatal closure compared to infants who had MM repair after birth. METHODS The Guidelines Task Force developed search terms and strategies to search PubMed and Embase for the relevant literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used. Full text articles were reviewed and, when appropriate, included as evidence. RESULTS A total of 261 abstracts were reviewed. Fifty-four full-text articles were selected for further analysis. Three studies met inclusion criteria. CONCLUSION There was Class II evidence from 1 study and Class III evidence from another 2 studies demonstrating that TCS develops in infants with prenatal MM closure at an equal or higher rate than with postnatal closure. There was an increased risk of development of inclusion cysts in infants who underwent in utero closure. Continued surveillance for TCS and/or the development of inclusion cysts in children with prenatal and postnatal closure of MM is indicated (Level II). Differences between prenatal and postnatal repair with respect to the development of TCS and/or inclusion cysts should be considered alongside other relevant maternal and fetal outcomes when deciding upon a preferred method for MM closure. The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-6.

scholarly journals Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Pediatric Myelomeningocele: Executive Summary

Neurosurgery ◽  
2019 ◽  
Vol 85 (3) ◽  
pp. 299-301 ◽  
Author(s):  
Catherine A Mazzola ◽  
Nadege Assassi ◽  
Lissa C Baird ◽  
David F Bauer ◽  
Alexandra D Beier ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spina Bifida ◽  
Task Force ◽  
The United States ◽  
Folic Acid Deficiency ◽  
Evidence Based ◽  
Executive Summary ◽  
Full Text Review ◽  
Level I ◽  
The Impact

Abstract BACKGROUND The incidence of spina bifida (SB) in the developing world is higher than in the United States because of malnutrition and folic acid deficiency during pregnancy. Advances in technology have made prenatal repair of myelomeningocele (MM) possible. OBJECTIVE The objective of the guidelines are, (1) To create clinical recommendations for best practices, based on a systematic review and analysis of available literature, (2) to obtain multi-disciplinary endorsement of these guidelines from relevant organizations, and (3) to disseminate the educational content to physicians to improve the care of infants with MM. METHODS The Guidelines Task Force developed search terms and strategies used to search PubMed and Embase for literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used to screen abstracts and to develop a list of relevant articles for full-text review. RESULTS Guidelines authors aimed to systematically review the literature and make evidence based recommendations about the timing of closure after birth, hydrocephalus, the impact of prenatal closure, and the effect of prenatal closure on ambulation ability and tethered spinal cord. Evidence concerning persistent ventriculomegaly and cognitive impairment was also evaluated. Hundreds of abstracts were identified and reviewed for each of the 5 topics. A total of 14 studies met stringent inclusion criteria. CONCLUSION Based on a comprehensive systematic review, a total of 5 clinical practice recommendations were developed, with 1 Level I, 2 Level II and 2 Level III recommendations. The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-1.

Tethered Cord Syndrome Following Spina Bifida Aperta

1990 ◽  
pp. 158-162 ◽  
Author(s):  
R. I. HogenEsch ◽  
D. J. Zeilstra ◽  
S. M. E. Breukers ◽  
G. P. A. Wiertsema ◽  
J. H. Begeer ◽  
...  
Keyword(s):  
Spina Bifida ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Spina Bifida Aperta

scholarly journals Tethered cord syndrome with spina bifida aperta in cats: two case reports of different types

2017 ◽  
Vol 3 (1) ◽  
pp. 205511691770806 ◽  
Author(s):  
Masahiro Tamura ◽  
Takashi Oji ◽  
Satoshi Une ◽  
Makiko Mukaino ◽  
Tatsuro Bekki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Urinary Incontinence ◽  
Spina Bifida ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Tethered Spinal Cord ◽  
Dural Sac ◽  
Spina Bifida Aperta ◽  
Different Types ◽  
Progressive Paraparesis

Case summary Two castrated male cats, aged 8 months old (case 1) and 10 months old (case 2), showed a history of progressive paraparesis, an over-reaching pelvic limb gait, urinary incontinence and a palpable dermoid fistula. In case 1, the fistula was connected to the dural sac on the conus medullaris, and the tethered spinal cord was retracted caudally. In case 2, the tubular structure was connected to the dural sac on the thoracic spinal cord, and the tethered spinal cord was retracted dorsally. Tethered cord syndrome secondary to spina bifida aperta was suspected in both cats. Excision of the fistula and release of the tethered spinal cord was performed. A histopathological examination confirmed the diagnosis of a meningomyelocele in case 1 and a meningocele in case 2. Paraparesis improved postoperatively in both cats. However, urinary incontinence in case 1 remained partially unresolved. Relevance and novel information This is the first report to describe the imaging characteristics, surgical treatments and outcomes of two different types of tethered cord syndrome with spina bifida aperta in cats. Tethered cord syndrome with spina bifida aperta needs to be included in the differential diagnosis of slowly progressive paraparesis in younger cats with or without vesicorectal failure and a palpable dermoid fistula.

Tethered Cord Syndrome: Clinical Signs and Results of Operation in 42 Patients with Spina Bifida Aperta and Occulta

1989 ◽  
Vol 44 (S 1) ◽  
pp. 5-7
Author(s):  
J. Begeer ◽  
G.P Wiertsema ◽  
S.M. Breukers ◽  
J.J. Mooy ◽  
C.A. ter Weeme
Keyword(s):  
Spina Bifida ◽  
Clinical Signs ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Spina Bifida Aperta

scholarly journals Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Incidence of Shunt-Dependent Hydrocephalus in Infants With Myelomeningocele After Prenatal Versus Postnatal Repair

Neurosurgery ◽  
2019 ◽  
Vol 85 (3) ◽  
pp. E405-E408 ◽  
Author(s):  
Mandeep S Tamber ◽  
Ann Marie Flannery ◽  
Catherine McClung-Smith ◽  
Nadege Assassi ◽  
David F Bauer ◽  
...  
Keyword(s):  
Full Text ◽  
Task Force ◽  
Pediatric Population ◽  
Relevant Literature ◽  
Significant Proportion ◽  
Fetal Surgery ◽  
Class Iii ◽  
Cerebrospinal Fluid Diversion ◽  
Level I ◽  
Prenatal Surgery

Abstract BACKGROUND Myelomeningocele (MM) is a condition that is responsible for considerable morbidity in the pediatric population. A significant proportion of the morbidity related to MM is attributable to hydrocephalus and the surgical management thereof. Postnatal repair remains the most common form of treatment; however, increased rates of prenatal diagnosis, advances in fetal surgery, and a hypothesis that neural injury continues in utero until the MM defect is repaired have led to the development and evaluation of prenatal surgery as a means to improve outcomes in afflicted infants. OBJECTIVE The objective of this guideline is to systematically evaluate the literature to determine whether there is a difference in the proportion of patients who develop shunt-dependent hydrocephalus in infants who underwent prenatal MM repair compared to infants who had postnatal repair. METHODS The Guidelines Task Force developed search terms and strategies used to search PubMed and Embase for relevant literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used to screen abstracts and to develop a list of relevant articles for full-text review. Full-text articles were then reviewed, and when appropriate, included as evidence. RESULTS A total of 87 abstracts were identified and reviewed by 3 independent reviewers. Thirty-nine full-text articles were selected for analysis. Three studies met selection criteria and were included in the evidence table. CONCLUSION Class I evidence from 1 study and class III evidence from 2 studies suggest that, in comparison to postnatal repair, prenatal surgery for MM reduces the risk of developing shunt-dependent hydrocephalus. Therefore, prenatal repair of MM is recommended for those fetuses who meet specific criteria for prenatal surgery to reduce the risk of developing shunt-dependent hydrocephalus (level I). Differences between prenatal and postnatal repair with respect to the requirement for permanent cerebrospinal fluid diversion should be considered alongside other relevant maternal and fetal factors when deciding upon a preferred method of MM closure.  The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-2.

scholarly journals Spinal cord stimulation for recurrent tethered cord syndrome in a pediatric patient: case report

2016 ◽  
Vol 18 (1) ◽  
pp. 105-110 ◽  
Author(s):  
Rachana Tyagi ◽  
Carolyn Kloepping ◽  
Shruti Shah
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Treatment Options ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Dorsal Spinal Cord ◽  
Increased Risk ◽  
Permanent Implant ◽  
Dorsal Spinal ◽  
Initial Results

The authors present a patient with a lipomyelomeningocele and worsening back pain due to recurrent tethered cord syndrome. Because of the increased risk and unlikely improvement in symptoms with repeated surgical untethering, she was offered an alternative treatment with a trial of dorsal spinal cord stimulation. She had an excellent response to the percutaneous trial, and a permanent implant was placed, with good initial results. The authors review her case as well as the treatment options, indications, and outcomes for recurrent tethered cord syndrome.

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