{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:05:04Z","timestamp":1787025904900,"version":"build-2736575974"},"reference-count":51,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2020,12,22]],"date-time":"2020-12-22T00:00:00Z","timestamp":1608595200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PRM"],"published-print":{"date-parts":[[2020,12,22]]},"abstract":"<jats:p>Myelomeningocele (MMC) arises from an early neural developmental anomaly and results in a variety of structural abnormalities and associated functional neurologic deficits. As such, neurologic issues are central to virtually all clinical problems. Neurosurgical intervention strives to correct or improve these defects and prevent secondary complications. These interventions include closure of the open myelomeningocele and management (across the life span) of hydrocephalus, the Chiari II malformation (C2M) and tethered spinal cord (TSC). The development of pre-natal closure techniques and reports of improved outcome with in-utero closure (IUMC) have revolutionized the neurosurgical approach to myelomeningocele. Controversies remain surrounding patient selection, maternal risks, technique of IUMC (endoscopic vs. open) and long-term outcomes. However, real gains include reduced rates of hydrocephalus, modestly improved motor capabilities and reduction in C2M morbidity. For many decades, the cornerstone of treatment of hydrocephalus for many decades has been the placement and support of ventricular shunts. Endoscopic third ventriculostomy (ETV) with or without choroid plexus coagulation (ETV\/CPC) is an appealing alternate strategy that avoids the morbidity and complications associated with shunts. The exact criteria for ETV-CPC candidacy and best metrics for outcome analysis remain active areas of debate and controversy. Similarly, neurosurgical management C2M, has centered upon the indications and clinical thresholds for performing posterior fossa surgical decompression. Tethered spinal cord management incorporates the diagnosis and surgical management of adhesions formed at the initial closure site, the consequent longitudinal traction related stress on the cord and the resulting neurologic signs and symptoms.<\/jats:p>","DOI":"10.3233\/prm-200782","type":"journal-article","created":{"date-parts":[[2020,12,9]],"date-time":"2020-12-09T00:26:32Z","timestamp":1607473592000},"page":"467-477","source":"Crossref","is-referenced-by-count":16,"title":["Neurosurgery guidelines for the care of people with spina bifida"],"prefix":"10.1177","volume":"13","author":[{"given":"Jeffrey P.","family":"Blount","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Alabama Children\u2019s Hospital and University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Bowman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lurie Children\u2019s Hospital of Chicago and Northwestern University College of Medicine, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark S.","family":"Dias","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Penn State Hershey Children\u2019s Hospital and Penn State College of Medicine, Hershey, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betsy","family":"Hopson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Alabama Children\u2019s Hospital and University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Partington","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Mercy Hospital and University of Kansas School of Medicine, Kansas City, KA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon G.","family":"Rocque","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Alabama Children\u2019s Hospital and University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","reference":[{"key":"10.3233\/PRM-200782_ref1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1136\/adc.39.203.41","article-title":"The natural history of Spina Bifida cystica: detailed analysis of 407 cases","volume":"39","author":"Laurence","year":"1964","journal-title":"Arch Dis Child"},{"key":"10.3233\/PRM-200782_ref2","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1159\/000056005","article-title":"Spina Bifida Outcome: a 25 year prospective","volume":"34","author":"Bowman","year":"2001","journal-title":"Pediatr Neurosurg"},{"key":"10.3233\/PRM-200782_ref3","first-page":"368","article-title":"Myelomeningocele: long term neurosurgical treatment and follow up in 202 patients","volume":"107","author":"Talamonti","year":"2007","journal-title":"J Neurosurg"},{"key":"10.3233\/PRM-200782_ref4","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/BF00298448","article-title":"Long-term outcome and complications of children born with myelomeningocele","volume":"8","author":"Steinbok","year":"1992","journal-title":"Childs Nervous System"},{"key":"10.3233\/PRM-200782_ref5","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1002\/pd.2199","article-title":"Postnatal management and outcome for neural tube defects including Spina Bifida and encephaloceles","volume":"29","author":"Thompson","year":"2009","journal-title":"Prenat Diagn"},{"key":"10.3233\/PRM-200782_ref6","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1056\/NEJMoa1014379","article-title":"A randomized trial of prenatal versus postnatal repair of myelomeningocele","volume":"364","author":"Adzick","year":"2011","journal-title":"NEJM"},{"key":"10.3233\/PRM-200782_ref7","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.siny.2009.05.002","article-title":"Fetal myelomeningocele: natural history, pathophysiology and in-utero intervention","volume":"15","author":"Adzick","year":"2010","journal-title":"Semin Fetal Med"},{"key":"10.3233\/PRM-200782_ref8","doi-asserted-by":"crossref","first-page":"265","DOI":"10.3171\/2011.12.PEDS11403","article-title":"Open fetal surgery for myelomeningocele; 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