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Pediatric neurosurgeons’ views regarding prenatal surgery for myelomeningocele and the management of hydrocephalus: a national survey
- Source :
- Neurosurgical Focus. 47:E8
- Publication Year :
- 2019
- Publisher :
- Journal of Neurosurgery Publishing Group (JNSPG), 2019.
-
Abstract
- OBJECTIVEThe Management of Myelomeningocele Study (MOMS) compared prenatal with postnatal surgery for myelomeningocele (MMC). The present study sought to determine how MOMS influenced the clinical recommendations of pediatric neurosurgeons, how surgeons’ risk tolerance affected their views, how their views compare to those of their colleagues in other specialties, and how their management of hydrocephalus compares to the guidelines used in the MOMS trial.METHODSA cross-sectional survey was sent to all 154 pediatric neurosurgeons in the American Society of Pediatric Neurosurgeons. The effect of surgeons’ risk tolerance on opinions and counseling of prenatal closure was determined by using ordered logistic regression.RESULTSCompared to postnatal closure, 71% of responding pediatric neurosurgeons viewed prenatal closure as either “very favorable” or “somewhat favorable,” and 51% reported being more likely to recommend prenatal surgery in light of MOMS. Compared to pediatric surgeons, neonatologists, and maternal-fetal medicine specialists, pediatric neurosurgeons viewed prenatal MMC repair less favorably (p < 0.001). Responders who believed the surgical risks were high were less likely to view prenatal surgery favorably and were also less likely to recommend prenatal surgery (p < 0.001). The management of hydrocephalus was variable, with 60% of responders using endoscopic third ventriculostomy in addition to ventriculoperitoneal shunts.CONCLUSIONSThe majority of pediatric neurosurgeons have a favorable view of prenatal surgery for MMC following MOMS, although less so than in other specialties. The reported acceptability of surgical risks was strongly predictive of prenatal counseling. Variation in the management of hydrocephalus may impact outcomes following prenatal closure.
- Subjects :
- Adult
Male
medicine.medical_specialty
Meningomyelocele
Prenatal counseling
medicine.medical_treatment
Ventriculoperitoneal Shunt
Ventriculostomy
03 medical and health sciences
Ventriculoperitoneal shunts
0302 clinical medicine
Pregnancy
Surveys and Questionnaires
Humans
Medicine
030212 general & internal medicine
Child
Aged
business.industry
Fetal surgery
Spina bifida
MOMS Trial
Endoscopic third ventriculostomy
Pediatric Surgeon
General Medicine
Middle Aged
medicine.disease
Hydrocephalus
Surgery
Cross-Sectional Studies
Neurosurgeons
Female
Neurology (clinical)
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 10920684
- Volume :
- 47
- Database :
- OpenAIRE
- Journal :
- Neurosurgical Focus
- Accession number :
- edsair.doi.dedup.....8358f3074acf3d17d13abfa2d30c8f3b
- Full Text :
- https://doi.org/10.3171/2019.7.focus19406