Pediatric Myelomeningocele Clinical Practice Guidelines (2019)

Congress of Neurological Surgeons (CNS)

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

October 03, 2019

The Congress of Neurological Surgeons (CNS) issued clinical practice guidelines for pediatric myelomeningocele in September 2019.[1]

Prenatal myelomeningocele repair is recommended in fetuses who meet fetal and maternal Management of Myelomeningocele Study (MOMS)–specified criteria for prenatal surgery to decrease the likelihood of shunt-dependent hydrocephalus.

The method of myelomeningocele closure chosen should be based on differences between prenatal and postnatal repair in terms of the need for permanent cerebrospinal fluid diversion, in addition to other relevant fetal and maternal factors.

In fetuses with prenatally diagnosed myelomeningocele who meet fetal and maternal MOMS inclusion criteria, prenatal myelomeningocele closure is recommended. It may improve short-term ambulatory status (at age 30 months).

The long-term benefit of prenatal closure on ambulatory status has not been determined. Children who have undergone prenatal or postnatal closure should be monitored closely for tethered spinal cord and resulting loss of ambulatory function.

It is unknown whether myelomeningocele closure performed within 48 hours of birth decreases the risk of wound infection.

If myelomeningocele closure is delayed beyond 48 hours, antibiotic therapy should be initiated.

Whether ventricular size and morphology affect neurocognitive development is unknown.

Children who have undergone prenatal or postnatal myelomeningocele closure should be monitored for tethered cord syndrome and/or inclusion cysts, as prenatal closure has been shown to increase the risk of recurrent tethered cord more so than postnatal closure.

For more information, please go to Surgery for Spina Bifida.

For more Clinical Practice Guidelines, please go to Guidelines.

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