Myelomeningocele repair in Latin America: a systematic review.

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.