Vazquez Sima, Lu Victor M, Brun Jorge, Muller José M, Niazi Toba N
1Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, Florida.
2Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, Florida.
J Neurosurg Pediatr. 2024 Nov 29;35(3):222-228. doi: 10.3171/2024.8.PEDS24265. Print 2025 Mar 1.
Myelomeningocele (MMC) carries high morbidity and mortality. The Management of Myelomeningocele Study (MOMS) showed improved outcomes after prenatal compared to postnatal repair. However, it is unclear how the MOMS trial affected practice and outcomes in the Latin American region. The objective of this study was to review the literature published by or including patients from the Latin American region and the reported management patterns of MMC.
A systematic review of MMC repair was performed. Articles were included if the senior author or patient population was from a Latin American country or territory. Article characteristics such as senior author, title, year of publication, senior author department, and outcomes studied were extracted. Management of MMC repair was the primary outcome explored.
A total of 71 studies satisfied all criteria for selection. Brazil (75%), Mexico (11%), Argentina (8%), Chile (7%), Costa Rica (1%), and Puerto Rico (1%) were represented countries or territories (some studies included patients from multiple countries). Neurosurgery (n = 23) was the most represented senior author department, followed by fetal medicine or fetal surgery (n = 15) and obstetrics (n = 14). Puerto Rico and Costa Rica described postnatal repair, while studies from Brazil, Chile, Argentina, and Mexico described prenatal repair. Brazil was the only country to prospectively study urological outcomes, reporting little to no improvement in urological outcomes with pre- versus postnatal repair. Prospective studies showed the safety and efficacy of endoscopic, microhysterotomy, and microneurosurgical approaches to in utero surgery.
Six countries or territories in the Latin American region have published articles on MMC repair. All recent papers describe a prenatal approach. Prospective studies show a trend toward open fetal microhysterotomy and microneurosurgery in the region and a need for more research on long-term urological outcomes following in utero repair.
脊髓脊膜膨出（MMC）具有较高的发病率和死亡率。脊髓脊膜膨出管理研究（MOMS）表明，与出生后修复相比，产前修复后的结局有所改善。然而，尚不清楚MOMS试验如何影响拉丁美洲地区的医疗实践和结局。本研究的目的是回顾拉丁美洲地区发表的或纳入该地区患者的文献以及所报道的MMC管理模式。
对MMC修复进行系统评价。如果资深作者或患者群体来自拉丁美洲国家或地区，则纳入相关文章。提取文章的特征，如资深作者、标题、发表年份、资深作者所在科室以及所研究的结局。MMC修复的管理是探索的主要结局。
共有71项研究符合所有入选标准。所代表的国家或地区包括巴西（75%）、墨西哥（11%）、阿根廷（8%）、智利（7%）、哥斯达黎加（1%）和波多黎各（1%）（一些研究纳入了来自多个国家的患者）。资深作者所在科室中神经外科（n = 23）占比最高，其次是胎儿医学或胎儿外科（n = 15）和产科（n = 14）。波多黎各和哥斯达黎加描述了出生后修复，而来自巴西、智利、阿根廷和墨西哥的研究描述了产前修复。巴西是唯一前瞻性研究泌尿系统结局的国家，报告显示产前与产后修复在泌尿系统结局方面几乎没有改善。前瞻性研究表明，内镜、微型子宫切开术和显微神经外科手术用于子宫内手术具有安全性和有效性。
拉丁美洲地区的六个国家或地区发表了关于MMC修复的文章。所有近期论文均描述了产前方法。前瞻性研究表明，该地区有采用开放性胎儿微型子宫切开术和显微神经外科手术的趋势，并且需要对子宫内修复后的长期泌尿系统结局进行更多研究。
