{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:51:28Z","timestamp":1792083088869,"version":"4.4.0"},"reference-count":7,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T00:00:00Z","timestamp":1740355200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T00:00:00Z","timestamp":1740355200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Leipzig"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Childs Nerv Syst"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The management of open neural tube defects (ONTD) has significantly improved with fetal surgery, but many children remain ineligible for fetal therapy. This study assesses the impact of intraoperative neurophysiological monitoring (IONM) during postnatal myelomeningocele (MMC) repair and its potential to optimize functional outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>Seven newborns with thoracolumbar or lumbar MMC underwent postnatal surgical repair using IONM. Neuromonitoring included motor-evoked potentials (MEP), sensory-evoked potentials (SEP), electromyography (EMG), and bulbocavernosus reflex (BCR). Preoperative neurological assessments were compared with postnatal outcomes at 2\u00a0years, along with anatomical levels on MRI and IONM results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At birth, 6 of 7 newborns showed better functional levels than expected by the anatomical level of the ONTD in fetal MRI. Intraoperative EMG responses were normal in all but one patient, but only 30% of patients had normal MEP and SEP responses. IONM was useful to detect undue mechanical stress during ONTD repair surgery and intraoperative identification of functional nerve roots. Neurological function deteriorated in the early postoperative period but stabilized at a level above the anatomical MRI level in 85% of the patients by 2\u00a0years of age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>IONM in postnatal ONTD repair is a safe and valuable tool that has the potential to increase surgical safety by detecting undue mechanical stress to the neural structure. Standardized postnatal management strategies, including the use of IONM, should be refined. Further studies are necessary to evaluate the prognostic value of EMG during postnatal surgery and its potential to result in better long-term outcome by preventing additional intraoperative damage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00381-025-06778-5","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T05:06:05Z","timestamp":1740373565000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The potential impact of intraoperative neurophysiological monitoring on neurological function outcomes after postnatal spina bifida repair"],"prefix":"10.1007","volume":"41","author":[{"given":"Matthias","family":"Krause","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Leibnitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias Manfred","family":"Kn\u00fcpfer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Merkenschlager","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph J.","family":"Griessenauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janina","family":"Gburek-Augustat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,24]]},"reference":[{"key":"6778_CR1","doi-asserted-by":"publisher","unstructured":"Adzick NS, Thom EA, Spong CY, Brock JW 3rd, Burrows PK, Johnson MP, Howell LJ, Farrell JA, Dabrowiak ME, Sutton LN, Gupta N, Tulipan NB, D'Alton ME, Farmer DL; MOMS investigators. 2011 A Randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med. 364(11):993\u20131004. https:\/\/doi.org\/10.1056\/NEJMoa1014379","DOI":"10.1056\/NEJMoa1014379"},{"key":"6778_CR2","doi-asserted-by":"publisher","unstructured":"Brock JW 3rd, Thomas JC, Baskin LS, Zderic SA, Thom EA, Burrows PK, Lee H, Houtrow AJ, MacPherson C, Adzick NS; Eunice Kennedy Shriver NICHD MOMS Trial Group. 2019 Effect of prenatal repair of myelomeningocele on urological outcomes at school age. J Urol. 202(4):812\u2013818. https:\/\/doi.org\/10.1097\/JU.0000000000000334","DOI":"10.1097\/JU.0000000000000334"},{"issue":"4","key":"6778_CR3","doi-asserted-by":"publisher","first-page":"e205674","DOI":"10.1001\/jamapediatrics.2020.5674","volume":"175","author":"AJ Houtrow","year":"2021","unstructured":"Houtrow AJ, MacPherson C, Jackson-Coty J, Rivera M, Flynn L, Burrows PK, Adzick NS, Fletcher J, Gupta N, Howell LJ, Brock JW 3rd, Lee H, Walker WO, Thom EA (2021) Prenatal repair and physical functioning among children with myelomeningocele: a secondary analysis of a randomized clinical trial. JAMA Pediatr 175(4):e205674","journal-title":"JAMA Pediatr"},{"issue":"3","key":"6778_CR4","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1002\/uog.20188","volume":"53","author":"A Inversetti","year":"2019","unstructured":"Inversetti A, Van der Veeken L, Thompson D, Jansen K, Van Calenbergh F, Joyeux L, Bosteels J, Deprest J (2019) Neurodevelopmental outcome of children with spina bifida aperta repaired prenatally vs postnatally: systematic review and meta-analysis. Ultrasound Obstet Gynecol 53(3):293\u2013301. https:\/\/doi.org\/10.1002\/uog.20188","journal-title":"Ultrasound Obstet Gynecol"},{"key":"6778_CR5","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1007\/978-3-031-34981-2_3","volume":"47","author":"S Eibach","year":"2023","unstructured":"Eibach S, Pang D (2023) A new surgical paradigm for postnatal repair of open neural tube defects using intraoperative neurophysiology monitoring. Adv Tech Stand Neurosurg 47:49\u201364. https:\/\/doi.org\/10.1007\/978-3-031-34981-2_3","journal-title":"Adv Tech Stand Neurosurg"},{"key":"6778_CR6","doi-asserted-by":"crossref","unstructured":"Brun B , Wille DA, Schauer SM, Moehrlen U, Meuli M, Latal B, Padden B, Spina Bifida Study Group Zurich. 2023 Motor function outcomes in children with open prenatal repair of Spina Bifida Aperta at 36-month follow-up: the Zurich cohort. J Pediatr Rehabil Med. 16(4): 595\u2013604","DOI":"10.3233\/PRM-220096"},{"issue":"2","key":"6778_CR7","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1007\/s00381-018-3984-6","volume":"35","author":"G Cohrs","year":"2019","unstructured":"Cohrs G, Drucks B, S\u00fcrie JP, Vokuhl C, Synowitz M, Held-Feindt J, Knerlich-Lukoschus F (2019) Expression profiles of pro-inflammatory and pro-apoptotic mediators in secondary tethered cord syndrome after myelomeningocele repair surgery. Childs Nerv Syst 35(2):315\u2013328. https:\/\/doi.org\/10.1007\/s00381-018-3984-6","journal-title":"Childs Nerv Syst"}],"container-title":["Child's Nervous System"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00381-025-06778-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00381-025-06778-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00381-025-06778-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T13:18:47Z","timestamp":1770815927000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00381-025-06778-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,24]]},"references-count":7,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["6778"],"URL":"https:\/\/doi.org\/10.1007\/s00381-025-06778-5","relation":{},"ISSN":["0256-7040","1433-0350"],"issn-type":[{"value":"0256-7040","type":"print"},{"value":"1433-0350","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,24]]},"assertion":[{"value":"11 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 February 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 February 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"119"}}