{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T11:14:04Z","timestamp":1790421244770,"version":"4.1.0"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,13]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>How hydrocephalus rates and brain development differ between myelomeningocele (MMC; with overlying sac) and myeloschisis (without overlying sac) is poorly understood. In this study, the authors compare rates of and age at CSF diversion as well as brain anatomy in patients with MMC and myeloschisis after prenatal and postnatal repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Demographic and clinical data were retrospectively collected from open spinal dysraphism patients who underwent prenatal or postnatal repair between 2015 and 2024 at Washington University in St. Louis. The need for and timing of permanent CSF diversion and brain imaging characteristics on the first postnatal MRI examination were compared by lesion type (myeloschisis vs MMC). The following imaging characteristics were examined: ventricular anatomy; corpus callosum, massa intermedia, tectum, and septum pellucidum morphology; the presence of gray matter heterotopias; hindbrain herniation; and medullary kinking\/compression\/displacement below foramen magnum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 98 patients (48% female, 88% Caucasian) were included. There were 21 (21%; 9 prenatal repair, 12 postnatal repair) myeloschisis and 77 (79%; 29 prenatal repair, 48 postnatal repair) MMC patients with similar distribution of lesion levels (p = 0.115). After both prenatal (relative risk [RR] 2.17, 95% CI 1.14\u20135.62) and postnatal (RR 1.33, 95% CI 1.07\u20131.65) repair, more patients with myeloschisis than MMC required CSF diversion. Those with prenatally repaired MMC (median 94 days, range 15\u2013154 days) underwent CSF diversion earlier than those with myeloschisis (median 210 days, range 13\u2013357 days) (Hodges-Lehmann \u0394114, 95% CI 2\u2013226). However, this was no longer significant after adjusting for fetal atrial diameter, the presence of hindbrain herniation, and medullary compression (\u03b2 = 75 days, 95% CI \u221278 to 229). There were minimal differences in brain imaging characteristics except for an increased presence of hindbrain herniation (4 [44%] myeloschisis patients vs 6 [21%] MMC patients; \u039423.8, 95% CI \u221211.9 to 59.4) and a decreased presence of posterior fossa crowding (2 [22%] myeloschisis patients vs 15 [52%] MMC patients; \u039430.3, 95% CI 3.0\u201362.1) in patients with myeloschisis versus MMC that was repaired prenatally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Patients with myeloschisis have an increased need for CSF diversion after both prenatal and postnatal repair compared to those with MMC, which may be a consequence of increased rates of hindbrain herniation. The timing of CSF diversion after prenatal repair occurs later in patients with myeloschisis, which may be a consequence of lower rates of medullary compression. These findings suggest that there may be differences in pathophysiology between lesion types and may help with patient counseling.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.10.peds25173","type":"journal-article","created":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T01:30:50Z","timestamp":1773451850000},"page":"553-564","source":"Crossref","is-referenced-by-count":1,"title":["Myelomeningocele versus myeloschisis: comparison of brain development and need for CSF diversion"],"prefix":"10.3171","volume":"37","author":[{"given":"Sasidhar","family":"Karuparti","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis;"},{"name":"University of Missouri School of Medicine, Columbia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashlynn","family":"Lizer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Narro Garcia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Peglar Marsala","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jagruti","family":"Anadkat","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine H.","family":"Bligard","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Vrecenak","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Mian","sequence":"additional","affiliation":[{"name":"Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer M.","family":"Strahle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis;"},{"name":"Division of Pediatric Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"9448","key":"b1","series-title":"Lancet","first-page":"1885","article-title":"Spina bifida","volume":"364","author":"Mitchell LE","year":"2004","unstructured":"Mitchell LE, Adzick NS, Melchionne J, Pasquariello PS, Sutton LN, Whitehead AS. 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