Garg Stuti P, Shah Krish V, Lentskevich Marina, Yau Alice, Gosain Arun K
From the Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL.
Plast Reconstr Surg Glob Open. 2024 Dec 19;12(12):e6377. doi: 10.1097/GOX.0000000000006377. eCollection 2024 Dec.
Prenatal myelomeningocele (MMC) repair offers significant benefits over traditional postnatal repair, as demonstrated by the Management of Myelomeningocele Study trial. We characterize the current specialist involvement in prenatal and postnatal MMC repair.
The top 50 US News Children's Hospitals for Neonatology and Neurology/Neurosurgery were queried, resulting in 67 unique hospitals. Specialties involved in MMC repair were extracted via hospital websites and surveys.
Among the 58 hospitals included, only 18 (31%) offered both prenatal and postnatal MMC repair, and the remaining 40 (69%) offered postnatal repair only. Of the 40 hospitals offering postnatal repair only, neurosurgeons (n = 38), orthopedic surgeons (n = 34), and urologists (n = 33) were most often included. Of the 18 hospitals with prenatal repair, neurosurgeons (n = 18) and maternal-fetal medicine specialists (n = 14) were most commonly involved. Prenatal teams had pediatric and fetal surgeons involved more often than postnatal teams ( = 0.011 and = 0.035, respectively). Only 7 prenatal teams included fellowship-trained fetal surgeons. Teams led by fetal surgeons always included neurosurgeons (n = 7) and maternal-fetal medicine specialists (n = 7) and were least likely to include plastic surgeons (n = 1).
These data emphasize both the delayed adaptation of fetal repair of MMC by major children's hospitals and lack of fellowship-trained specialists involved; only 31% of the major children's hospitals offer prenatal repair of MMC, with only 39% of those hospitals being led by a fellowship-trained fetal surgeon. These data highlight the need for additional teams trained in prenatal MMC repair as well as the standardization of fetal surgery fellowships to allow for the development of prenatal repair teams.
如脊髓脊膜膨出症管理研究试验所示，产前脊髓脊膜膨出症（MMC）修复术相较于传统产后修复术具有显著优势。我们对目前参与产前和产后MMC修复的专科医生情况进行了描述。
查询了美国新闻周刊排名前50的新生儿科和神经科/神经外科儿童医院，共得到67家不同的医院。通过医院网站和调查提取参与MMC修复的专科。
在纳入的58家医院中，只有18家（31%）同时提供产前和产后MMC修复，其余40家（69%）仅提供产后修复。在仅提供产后修复的40家医院中，神经外科医生（n = 38）、整形外科医生（n = 34）和泌尿科医生（n = 33）是最常参与的。在18家开展产前修复的医院中，神经外科医生（n = 18）和母胎医学专家（n = 14）是最常参与的。产前团队中儿科和胎儿外科医生的参与频率高于产后团队（分别为 = 0.011和 = 0.035）。只有7个产前团队有接受过专项培训的胎儿外科医生。由胎儿外科医生领导的团队总是包括神经外科医生（n = 7）和母胎医学专家（n = 7），且最不可能包括整形外科医生（n = 1）。
这些数据强调了大型儿童医院对胎儿MMC修复的适应延迟以及缺乏接受过专项培训的专科医生参与；只有31%的大型儿童医院提供产前MMC修复，其中只有这些医院的39%由接受过专项培训的胎儿外科医生领导。这些数据凸显了需要更多接受产前MMC修复培训的团队以及规范胎儿手术专项培训以促进产前修复团队的发展。
