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J Neurosurg Pediatr 2019 Apr 19:1-10. Epub 2019 Apr 19.

1Department of Neurosurgery.

OBJECTIVESurgical repair and closure of myelomeningocele (MMC) defects are important and vital, as the mortality rate is as high as 65%-70% in untreated patients. Closure of large MMC defects is challenging for pediatric neurosurgeons and plastic surgeons. The aim of the current study is to report the operative characteristics and outcome of a series of Iranian patients with large MMC defects utilizing the V-Y flap and with latissimus dorsi or gluteal muscle advancement. Read More

J Neurosurg Pediatr 2019 Apr 19:1-6. Epub 2019 Apr 19.

1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville.

OBJECTIVEAt failure of endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC), the ETV ostomy may be found to be closed or open. Failure with a closed ostomy may indicate a population that could benefit from evolving techniques to keep the ostomy open and may be candidates for repeat ETV, whereas failure with an open ostomy may be due to persistently abnormal CSF dynamics. This study seeks to identify clinical and radiographic predictors of ostomy status at the time of ETV/CPC failure. Read More

Front Pediatr 2019 2;7:118. Epub 2019 Apr 2.

Department of Urology, Charité Medical University of Berlin, Berlin, Germany.

We reviewed the literature addressing outcomes of fetal intervention of conditions that require post-natal urological management including lower urinary tract obstruction, hydrometrocolpos, congenital adrenal hyperplasia, and myelomeningocele. Despite several decades of fetal intervention for these conditions, benefits remain elusive in part because of the enormous difficulty of conducting prospective randomized studies. In this review, we reached the following conclusions: Prenatal intervention in lower urinary tract obstruction (LUTO) improves survival in the worst cases by improving pulmonary function and it may be advantageous for renal function, particularly in patients with adverse urine parameters. Read More

Birth Defects Res 2019 Apr 15. Epub 2019 Apr 15.

Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.

Objectives: Mothers need a nutrient-rich diet for healthy neural tube development. Neural tube defect risk can be reduced through fortifying grain products with folic acid and taking folic acid supplements. Fortification is not required in Bangladesh. Read More

Front Pediatr 2019 29;7:91. Epub 2019 Mar 29.

Division of Pediatric Urology, Department of Pediatric Surgery, University Children's Hospital, Zurich, Switzerland.

Several congenital disorders can cause end stage bladder disease and possibly renal damage in children. The current gold standard therapy is enterocystoplasty, a bladder augmentation using an intestinal segment. However, the use of bowel tissue is associated with numerous complications such as metabolic disturbance, stone formation, urine leakage, chronic infections, and malignancy. Read More

Indian Dermatol Online J 2019 Mar-Apr;10(2):186-187

Department of Pediatrics, PGIMER, Chandigarh, India.

Disabil Rehabil 2019 Apr 12:1-7. Epub 2019 Apr 12.

a Department of Psychology , Loyola University Chicago , Chicago , IL , USA.

Purpose: Youth with disabilities are at higher risk for obesity, disordered eating, and poor body image but are often excluded from research on these domains. The current study is the first to characterize health behaviors, body mass index, and disordered eating cognitions and behaviors in a national sample of adolescent and young adult males and females with spina bifida.

Methods: Participants were recruited nationally through the support of a national spina bifida-related organization to complete an anonymous survey assessing health behaviors and disordered eating. Read More

Fetal Diagn Ther 2019 Apr 10:1-9. Epub 2019 Apr 10.

Department of Surgery, University of California Davis, Sacramento, California, USA.

Introduction: The surgically induced fetal lamb model is the most commonly used large animal model of myelomeningocele (MMC) but is subject to variation due to surgical technique during defect creation.

Material And Methods: Thirty-one fetal lambs underwent creation of the MMC defect, followed by defect repair with either an extracellular matrix (ECM) patch (n = 10) or ECM seeded with placental mesenchymal stromal cells (n = 21). Postnatal hindlimb function was assessed using the Sheep Locomotor Rating (SLR) scale. Read More

World Neurosurg 2019 Apr 4. Epub 2019 Apr 4.

Department of Neurosurgery.

Background: Endoscopic third ventriculostomy (ETV) is now widely used to manage ventriculoperitoneal shunt (VPS) malfunctions, but outcome predictors are still debated. Different opinions exist about the prognostic factors, but shunt duration is generally considered unimportant despite its influence remains poorly investigated.

Methods: 139 patients undergoing ETV for VPS malfunction were reviewed. Read More

Perm J 2019 ;23

University of California Irvine Medical Center, Orange.

Introduction: Preterm infants require intravenous (IV) access for administration of medications, IV fluids, and parenteral nutrition. The scalp is a common site for obtaining IV access, and in children with hydrocephalus or wide fontanelles and sutures, there is a high probability of penetrating the meninges and brain matter with the scalp IV needle. If this penetration occurs and remains unnoticed, the contents of the IV infusion can infiltrate into the brain and cause severe brain damage. Read More

J Pediatr Neurosci 2018 Oct-Dec;13(4):398-403

Department of Neurosurgery, Father Muller Medical College, Mangaluru, Karnataka, India.

Background: Open neural tube defects in the spine most commonly are in the lumbo-sacral region. Surgical closure is the treatment, but in primary closure the chances of CSF leak are more. Hence a novel technique of using an advancement flap called the V-Y plasty for closure of these defects(6). Read More

Childs Nerv Syst 2019 Mar 27. Epub 2019 Mar 27.

Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677, Lyon Cedex, France.

Background: Postnatal closure of a myelomeningocele remains the standard of care in many countries. The prenatal closure has given hope for decreasing the damage to the neural placode and has challenged classic management. However, this technique presents potential sources of complications. Read More

J Acquir Immune Defic Syndr 2019 Mar 19. Epub 2019 Mar 19.

Department of Clinical Safety and Risk Management.

Objective: To evaluate the risk of neural tube defects (NTDs) after exposure to raltegravir during pregnancy.

Methods: Exposures to raltegravir during pregnancy reported cumulatively through 31-May-2018 to the company safety database were reviewed to identify cases of NTDs. This database includes all reports of pregnancy from Merck-sponsored clinical trials, spontaneous post-marketing and non-interventional data sources, including the Antiretroviral Pregnancy Registry (APR). Read More

Scoliosis Spinal Disord 2019 8;14. Epub 2019 Mar 8.

2Department of Neurology, Haukeland University Hospital, Postbox 1400, 5020 Bergen, Norway.

Background: Myelomeningocele (MMC) is a congenital disorder that causes a variety of acute as well as late complications. Numerous health problems in adulthood have been described by the persons with MMC but not studied in clinical setting. This study gives implications for organization of the follow-up in adulthood. Read More

Am J Obstet Gynecol 2019 Mar 15. Epub 2019 Mar 15.

Colorado Fetal Care Center, Denver, CO.

Background: Open maternal-fetal surgery (OMFS) for fetal myelomeningocele (fMMC) results in reduction in neonatal morbidity related to spina bifida but may be associated with fetal, neonatal, and maternal complications in subsequent pregnancies.

Objective: The objective of this study was to ascertain obstetric risk in subsequent pregnancies after OMFS for fMMC closure.

Study Design: An international multicenter prospective observational registry created to track and report maternal, obstetric, fetal/neonatal and subsequent pregnancy outcomes following OMFS for fMMC, was evaluated for subsequent pregnancy outcome variables. Read More

Fetal Diagn Ther 2019 Mar 18:1-4. Epub 2019 Mar 18.

Department of Urology, CACAU-NUPEP, São Paulo, Brazil,

Introduction: After the successful results of in utero myelomeningocele (MMC) repair presented by the Management of Myelomeningocele Study, the concept of fetal surgery was introduced in our institution in 2011. Since then, we have been able to follow prospectively a group of patients with attention to urological care. In the present study, we were interested in estimating urinary and fecal continence in this new subset of patients. Read More

Congenit Anom (Kyoto) 2019 Mar 18. Epub 2019 Mar 18.

Department of Obstetrics and Gynecology, Kurume University Hospital, Kurume, Japan.

The vital role of folic acid is to reduce the risk of having a neonate afflicted with neural tube defects. The prevalence of neural tube defects (myelomeningocele and anencephaly) has been reported in an incomplete form over the last 40 years in Japan. We aimed to evaluate the total number of neural tube defects including those delivered or terminated, to clarify the proportion of those terminated, and to internationally compare their prevalence. Read More

J Int Neuropsychol Soc 2019 Mar;25(3):249-265

3Program in Neuroscience and Mental Health,The Hospital for Sick Children,Toronto,Canada.

Objectives: Fluency is a major problem for individuals with neurodevelopmental disorders, including fluency deficits for academic skills. The aim of this study was to determine neurocognitive predictors of academic fluency within and across domains of reading, writing, and math, in children and adults, with and without spina bifida. In addition to group differences, we expected some neurocognitive predictors (reaction time, inattention) to have similar effects for each academic fluency outcome, and others (dexterity, vocabulary, nonverbal reasoning) to have differential effects across outcomes. Read More

World J Urol 2019 Mar 12. Epub 2019 Mar 12.

Shahid Labbafinejad Medical Center, Urology Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No. 103, Boostan 9th St, Pasdaran Ave, Tehran, 1666663111, Iran.

Purpose: This study evaluated sacral neuromodulation's effectiveness for managing refractory neuropathic lower urinary tract dysfunction in children and adolescents.

Methods: Twenty-five children and adolescents underwent peripheral nerve evaluation test phase of sacral neuromodulation at our center. Thirteen (seven boys and six girls) cases suffered from neuropathic lower urinary tract dysfunction refractory to the maximum medical treatment. Read More

Plast Reconstr Surg Glob Open 2019 Jan 11;7(1):e2089. Epub 2019 Jan 11.

Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Mass.

Background: Lumbar spinal defects present a distinct challenge for the reconstructive surgeon and are often complicated by previous spinal surgery, the presence of hardware, and prior radiation. There are a variety of reconstructive options described but no clear treatment algorithm for these challenging defects.

Methods: A literature search was performed to review the described treatment options for lumbar spinal soft-tissue defects. Read More

BJU Int 2019 Apr;123(4):560-561

Pediatric Urology, Urology UCSF Benioff Children's Hospitals, University of California, San Francisco, CA, USA.

JBJS Rev 2019 Mar;7(3):e1

Developmental Pediatrics, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas.

Neurosciences (Riyadh) 2019 Jan;24(1):5-10

Department of Neurosurgery, Asir Central Hospital, Abha, Kingdom of Saudi Arabia. E-mail:

Major approaches have emerged in the field of myelomeningocele (MMC) management. The prevalence of MMC in Kingdom of Saudi Arabia is 0.44-1. Read More

Br J Neurosurg 2019 Mar 5:1-3. Epub 2019 Mar 5.

a Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , Neurosurgery , New Delhi , India.

Variations in split cord malformation (SCM) are known. However, association of SCM type I with myelomeningocele along with same level dorsal bony spur has not been described previously. We report a 1-year old male child who presented with these findings with associated syringomyelia, lipoma and tethered cord. Read More

Ultrasound Obstet Gynecol 2019 03;53(3):290-292

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA; and Texas Children's Hospital, Pavilion for Women, 6651 Main St., Suite 1040.20, Houston, TX, 77030, USA.

Linked Comment: Ultrasound Obstet Gynecol 2018; 53: 340-347. Read More

Pediatr Clin North Am 2019 04;66(2):295-308

Department of Surgery, Abramson Research Center, Room 1116B, 3615 Civic Center Boulevard, Philadelphia, PA 19104-4318, USA. Electronic address:

Fetal surgery is an established but still rapidly evolving specialty, born from the rationale that destructive embryologic processes, recognized early in gestation, can be curtailed by prenatal correction. As more and more centers begin offering fetal interventions, quality of care must be verified through transparency about clinical capabilities and resources. Level designations should be assigned based on capability, as in trauma and neonatal ICU centers for excellence, and volume requirements must be set for fetal surgery certification. Read More

J Neurosurg Pediatr 2019 Feb 22:1-9. Epub 2019 Feb 22.

2Neurological Surgery, University of Miami Miller School of Medicine.

OBJECTIVEHydrocephalus is recognized as a common disabling pediatric disease afflicting infants and children disproportionately in the developing world, where access to neurosurgical care is limited and risk of perinatal infection is high. This surgical case series describes the Project Medishare Hydrocephalus Specialty Surgery (PMHSS) program experience treating hydrocephalus in Haiti between 2008 and 2015.METHODSThe authors conducted a retrospective review of all cases involving children treated for hydrocephalus within the PMHSS program in Port-au-Prince, Haiti, from 2008 through 2015. Read More

Pediatr Neurosurg 2019 15;54(2):108-115. Epub 2019 Feb 15.

Departments of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania, USA,

Objective: This study aims to elucidate surgical risk factors in neuromuscular scoliosis (NMS) with respect to wound site infection after spinal fusion.

Methods: A retrospective review was performed of all patients treated surgically for NMS between January 2008 and December 2016 (minimum 6 months' follow-up). A sub-cohort of 60 patients with minimum 2 years of follow-up data was also analyzed. Read More

J Pediatr Rehabil Med 2018 ;11(4):243-254

Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.

Purpose: To describe pulmonary function and determine the impact of neurological level, scoliosis, and obesity on pulmonary function in people with spina bifida (SB).

Methods: Participants with SB (N= 29) (15 females; age, 30 ± 12 years) completed spirometry and body plethysmographic lung volume testing. Univariate and multivariate regression analyses were used to describe the factors associated with pulmonary function in people with SB. Read More

World Neurosurg 2019 Feb 5. Epub 2019 Feb 5.

Pediatric Neurosurgery Department, Hospital Virgen del Rocio, Avda. M Siurot n/n, Advanced Neurology Center, Avda M Siurot 43, 41013 Seville. Electronic address:

The release of the placode and reconstruction of the myelomeningocele preserving the maximum of neural tissue is a challenge for the neurosurgeons. Vascular fluorescence with indocyanine green and / or fluorescein allows to observe the microvascularization of the spinal cord and adequately identify viable tissue. Read More

Pediatr Rev 2019 Feb;40(2):e7-e10

Department of Neurosurgery, Children's Mercy Hospitals and Clinics, Kansas City, MO.

Birth Defects Res 2019 Mar 1;111(5):261-269. Epub 2019 Feb 1.

Department of Pediatrics, Selçuk University, Selçuklu Medical Faculty, Konya, Turkey.

Background: Additional congenital anomalies have often been found in patients with neural tube defect (NTD). We aimed to find out the clinical features, short term prognosis, treatment approaches, and systemic anomalies of NTD patients in the Konya region.

Method: A total of 186 newborn babies with NTD were retrospectively included in the study and all were assessed in detail for congenital anomalies and clinical features. Read More

No Shinkei Geka 2019 Jan;47(1):27-37

Department of Neurosurgery, Center for Neurological Diseases, Niigata Medical Center.

J Surg Res 2019 Mar 31;235:227-236. Epub 2018 Oct 31.

Department of Bioengineering, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado; Division of Pediatric Surgery, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado. Electronic address:

Background: Myelomeningocele (MMC) results in lifelong neurologic and functional deficits. Currently, prenatal repair of MMC closes the defect, resulting in a 50% reduction in postnatal ventriculoperitoneal shunting. However, this invasive fetal surgery is associated with significant morbidities to mother and baby. Read More

J Indian Assoc Pediatr Surg 2019 Jan-Mar;24(1):21-26

Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India.

Context: It is often a challenge to counsel parents with children operated for spina bifida aperta in developing countries. Data regarding the efficacy of simple measures and preventive are scarce.

Aims: The aim of this study is to study such children for the incidence, prevalence of bowel bladder dysfunction, and the quality of life (QOL) in children who are involved with a multidisciplinary team in India. Read More

J Craniofac Surg 2019 Jan 19. Epub 2019 Jan 19.

Division of Plastic Surgery.

Myelomeningocele (MMC) is a type of open neural tube defect characterized by exposure of the spinal cord through a defect in the skin and posterior hindbrain herniation through the foramen magnum. Outcomes vary but common morbidities include paraplegia, hydrocephalus, neurogenic bladder, scoliosis, and tethered cord. Fetal surgery, although not a cure, has been shown to decrease the risk of associated morbidity. Read More

Ultrasound Obstet Gynecol 2019 Mar;53(3):314-323

Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA.

Objective: The effect of fetoscopic myelomeningocele (MMC) repair on fetal growth is unknown. Fetal surgery itself and/or exposure to a carbon dioxide (CO ) environment during spina bifida repair may affect placental function and impair fetal growth. Our aim was to assess and compare growth in fetuses, neonates and infants who underwent prenatal fetoscopic or open MMC repair. Read More

Plast Reconstr Surg Glob Open 2018 Dec 14;6(12):e2012. Epub 2018 Dec 14.

Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan.

Major wound necrosis is an uncommon yet critical complication of meningomyelocele surgical repair with few reports available. Management is demanding and often requires further reconstructive surgery. We report a case of a neonate who developed extensive wound necrosis with dehiscence following primary repair of myelomeningocele. Read More

Neurospine 2018 Sep 4. Epub 2018 Sep 4.

Department of Neurosurgery, Kovai Medical Center and Hospital, Coimbatore, India.

Epidermoid cysts of the spine are rare tumors. While majority of them occur spontaneously, very few occur following a previous surgery for spinal dysraphism. Such tumors tend to occur at the site of previous surgery. Read More

Br J Neurosurg 2019 Jan 17:1-3. Epub 2019 Jan 17.

a Department of Plastic Reconstructive and Aesthetic Surgery , Cumhuriyet University Faculty of Medicine , Sivas , Turkey.

Background: Early closure of the meningocele, meningomyelocele, is essential to prevent complications such as hypothermia, infection in the postnatal period. But for some reasons, it is not always possible to repair early. The possibility of malign transformation should be considered in long-term due to nonhealing ulcers and cerebrospinal fluid (CSF) fistula and frequent infections in an adult patient with meningomyelocele. Read More

J Ayub Med Coll Abbottabad 2018 Oct-Dec;30(4):520-523

Department of Neurosurgery, Ayub Medical College, Abbottabad, Pakistan.

Background: Myelomeningocele is a congenital anomaly of Central Nervous System (CNS) leading to serious sequels related to various systems and organs of the affected patient. Hydrocephalus is a common condition associated with myelomeningocele. Hydrocephalus is seen in 11. Read More

Ultrasound Obstet Gynecol 2019 Mar;53(3):324-334

Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA.

Objective: To determine if brain imaging in fetuses that underwent prenatal repair of neural tube defect (NTD) can predict the need for postnatal hydrocephalus treatment (HT) in the first year postpartum.

Methods: This was a retrospective study of fetuses diagnosed with open NTD that had in-utero myelomeningocele repair between April 2014 and April 2016. Independent variables were collected from four chronological sets of fetal images: presurgery ultrasound, presurgery magnetic resonance imaging (MRI), 6-week postsurgery MRI and predelivery ultrasound. Read More

J Matern Fetal Neonatal Med 2019 Feb 3:1-6. Epub 2019 Feb 3.

a Department of Obstetrics and Gynecology , Fetal Medicine Unit, Regional Hospital , Rancagua , Chile.

Objective: To describe the use of a self-retaining thermoplastic polyurethane wound retractor for the management of hysterotomy during prenatal repair of myelomeningocele.

Methods: The preliminary experience with 16 consecutive cases of open surgery for prenatal repair of myelomeningocele using a new technique is presented. Under general anesthesia, the gravid uterus was partially exteriorized through a low transverse abdominal incision and a high 3-4-cm midline vertical mini-hysterotomy was performed. Read More

Anaesthesiol Intensive Ther 2018 ;50(5):385-386

Department of Anesthesiology and Intensive Therapy, Health Sciences University Medical School, Turkey.

Neurourol Urodyn 2018 Aug;37(S6):S61-S66

Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.

Aims: Videourodynamics is the addition of imaging to invasive urodynamics and one of the methods to ensure objective diagnosis in persons with signs or symptoms of lower urinary tract dysfunction. This manuscript has the aim to outline the basics of the practice of videourodynamics and to elementary explain interpretation of the results.

Methods: Literature sources and expert opinion were arranged to provide the reader with an introductory overview of current knowledge. Read More

Clin Imaging 2019 Mar - Apr;54:100-102. Epub 2018 Nov 20.

Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.

A classic metaphyseal lesion (CML) is highly specific for nonaccidental trauma. Missing CMLs can be devastating to the child as the child can continue to be exposed to inflicted trauma. Yet, there are rare case reports on CMLs that occur due to birth trauma, IV line placement, and treatment for clubfoot. Read More

Childs Nerv Syst 2019 Jan 4. Epub 2019 Jan 4.

Unit of Pediatric Neurosurgery, University Hospital La Fe, Valencia, Spain.

Background: Closure of the skin defect in myelomeningocele repair determines the quality of the surgical result. In large myelomeningoceles, the direct closure or by skin undermining may not be possible. In these cases, the skin defect must be closed using flaps to provide a tension-free and successful closure. Read More

Prenat Diagn 2019 Mar 10;39(4):269-279. Epub 2019 Feb 10.

Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA.

Objectives: To describe and compare placental and amniotic histology in women who underwent a fetoscopic myelomeningocele repair to those who underwent an open hysterotomy myelomeningocele repair. Also, we intended to compare findings from both prenatal repair groups to age-matched control pregnant patients.

Methods: Placental and membrane histopathology from 43 prenatally repaired spina bifida cases (17 fetoscopic and 26 open) and 18 healthy controls were retrospectively assessed. Read More

J Child Orthop 2018 Dec;12(6):575-581

Department of Orthopaedics, UZ Leuven Campus Pellenberg, Pellenberg, Belgium.

Purpose: Although non-idiopathic clubfeet were long thought to be resistant to non-surgical treatment methods, more studies documenting results on treatment of these feet with the Ponseti method are being published. The goal of this systematic review is to summarize current evidence on treatment of non-idiopathic clubfeet using the Ponseti method.

Methods: PubMed and Limo were searched, reference lists of eligible studies were screened and studies that met the inclusion criteria were included. Read More