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Neuroradiology Feb 2022Open spina bifida (OSB) encompasses a wide spectrum of intracranial abnormalities. With foetal surgery as a new treatment option, robust intracranial imaging is... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Open spina bifida (OSB) encompasses a wide spectrum of intracranial abnormalities. With foetal surgery as a new treatment option, robust intracranial imaging is important for comprehensive preoperative evaluation and prognostication. We aimed to determine the incidence of infratentorial and supratentorial findings detected by magnetic resonance imaging (MRI) alone and MRI compared to ultrasound.
METHODS
Two systematic reviews comparing MRI to ultrasound and MRI alone were conducted on MEDLINE, EMBASE, and Cochrane databases identifying studies of foetal OSB from 2000 to 2020. Intracranial imaging findings were analysed at ≤ 26 or > 26 weeks gestation and neonates (≤ 28 days). Data was independently extracted by two reviewers and meta-analysis was performed where possible.
RESULTS
Thirty-six studies reported brain abnormalities detected by MRI alone in patients who previously had an ultrasound. Callosal dysgenesis was identified in 4/29 cases (2 foetuses ≤ 26 weeks, 1 foetus under any gestation, and 1 neonate ≤ 28 days) (15.1%, CI:5.7-34.3%). Heterotopia was identified in 7/40 foetuses ≤ 26 weeks (19.8%, CI:7.7-42.2%), 9/36 foetuses > 26 weeks (25.3%, CI:13.7-41.9%), and 64/250 neonates ≤ 28 days (26.9%, CI:15.3-42.8%). Additional abnormalities included aberrant cortical folding and other Chiari II malformation findings such as lower cervicomedullary kink level, tectal beaking, and hypoplastic tentorium. Eight studies compared MRI directly to ultrasound, but due to reporting inconsistencies, it was not possible to meta-analyse.
CONCLUSION
MRI is able to detect anomalies hitherto underestimated in foetal OSB which may be important for case selection. In view of increasing prenatal OSB surgery, further studies are required to assess developmental consequences of these findings.
Topics: Brain; Female; Fetus; Humans; Infant, Newborn; Magnetic Resonance Imaging; Pregnancy; Spinal Dysraphism; Ultrasonography, Prenatal
PubMed: 34792623
DOI: 10.1007/s00234-021-02853-1 -
The Laryngoscope May 2024We undertook a systematic review of the literature with meta-analysis to identify the role of obesity (BMI ≥30) in the patient characteristics presenting with... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
We undertook a systematic review of the literature with meta-analysis to identify the role of obesity (BMI ≥30) in the patient characteristics presenting with spontaneous cerebrospinal fluid (sCSF) leaks of the lateral skull base and the outcomes of their repair.
DATA SOURCES
A Systematic Review of English Articles using MEDLINE, EMBASE, and Cochrane Library.
REVIEW METHODS
The research algorithm included the following keywords: "spontaneous CSF leak," "lateral skull base," "temporal bone," "meningocele," "encephalocele," and "otorrhea." We also manually searched the references of included studies, to identify possible studies missed during our literature search.
RESULTS
More than two-thirds of the patients were female (69.2%) and often were obese (mean BMI 36.5 kg/m) with a mean age of 57. Most common presenting symptoms were otorrhea and hearing loss. Most authors did not report a routine use of a post-operative lumbar drain. Most patients had a single skull base defect and encephaloceles prolapsing through, across obese and non-obese groups. Median length of stay in hospital was 3.2 days, and the majority of patients did not have any recurrence during their follow-up (89.6%), which was not affected by obesity.
CONCLUSION
Obesity does not affect length of hospital stay or recurrence rate following surgical repair of lateral skull base sCSF leaks. Surgical repair is a safe and viable approach in the management of obese patients with sCSF leaks in the temporal bone.
LEVEL OF EVIDENCE
NA Laryngoscope, 134:2012-2018, 2024.
Topics: Humans; Female; Middle Aged; Male; Retrospective Studies; Treatment Outcome; Skull Base; Cerebrospinal Fluid Leak; Obesity; Temporal Bone; Encephalocele
PubMed: 38400793
DOI: 10.1002/lary.31349 -
World Journal of Pediatrics : WJP Feb 2024Although birth defects are of great concern globally, the latest national prevalence has not yet been quantified in China. We conducted a systematic review and... (Review)
Review
BACKGROUND
Although birth defects are of great concern globally, the latest national prevalence has not yet been quantified in China. We conducted a systematic review and meta-analysis to estimate the perinatal prevalence of birth defects in the Mainland of China between 2000 and 2021.
METHODS
We performed a systematic literature search of six databases for relevant articles published between January 1, 2000, and March 1, 2023. We included published studies that reported data on the perinatal prevalence of birth defects in the Mainland of China. The DerSimonian and Laird random-effects models were used to estimate the pooled prevalence and its 95% confidence interval (CI). We also conducted subgroup analyses and univariable meta-regressions to explore differences in prevalence by time period, geographic region, and other characteristics.
RESULTS
We included 254 studies reporting the perinatal prevalence of birth defects and 86 studies reporting only the prevalence of specific types of birth defects. Based on 254 studies covering 74,307,037 perinatal births and 985,115 cases with birth defects, the pooled perinatal prevalence of birth defects was 122.54 (95% CI 116.20-128.89) per 10,000 perinatal births in the Mainland of China during 2000-2021. Overall, the perinatal prevalence of birth defects increased from 95.60 (86.51-104.69) per 10,000 in 2000-2004 to 208.94 (175.67-242.22) per 10,000 in 2020-2021. There were also significant disparities among different geographical regions. Congenital heart defects (33.35 per 10,000), clefts of the lip and/or palate (13.52 per 10,000), polydactyly (12.82 per 10,000), neural tube defects (12.82 per 10,000), and inborn errors of metabolism (11.41 per 10,000) were the five most common types of birth defects. The perinatal prevalence among males was significantly higher than that among females (β = 2.44 × 10, P = 0.003); a higher perinatal prevalence of birth defects was observed among perinatal births whose mothers were ≥ 35 years (β = 4.34 × 10, P < 0.001).
CONCLUSION
Comprehensive and sustained efforts are needed to strengthen surveillance and detection of birth defects, improve prenatal and postnatal healthcare, and promote rehabilitation, especially in underdeveloped areas.
PubMed: 38340146
DOI: 10.1007/s12519-023-00786-8 -
Child's Nervous System : ChNS :... Sep 2021Iatrogenic syringomyelia has previously been described preoperatively due to space occupying lesions and postoperatively predominantly postspinal CSF drainage....
INTRODUCTION
Iatrogenic syringomyelia has previously been described preoperatively due to space occupying lesions and postoperatively predominantly postspinal CSF drainage. Iatrogenic syringomyelia after cranial surgery is a rare entity. The purpose of this study is to review the current literature for iatrogenic syringomyelia following cranial surgery in children.
MATERIAL AND METHODS
We performed a systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and meta-analyses) guidelines. Using keywords "de novo," "acquired," "iatrogenic," "postoperative development," and "syringomyelia," we searched PubMed and Scopus databases. We paid particular attention to type of surgery, clinical presentation, management, and outcome. We also present a relevant case report, operated on at John Radcliffe Hospital, Oxford.
RESULTS
The systematic literature review provided 19 cases of iatrogenic syringomyelia postcranial surgery in pediatric patients, in addition to our case report, resulting in a total of 20 cases reported. The patients' mean age at surgery preceding syringomyelia was 8.1 years (range 0.1-17) with a female sex predilection (2.7:1). The mean time of manifestation of the iatrogenic syringomyelia after surgery was 5.7 years (range 0.1-51), and the median time to presentation was 1.7 years. Nine children had surgery for Chiari I malformation before formation of the syrinx, 8 patients underwent shunt surgery, 2 children had intracranial tumor surgery, and 1 patient had lambdoid and sagittal suturectomy for scaphocephaly before developing a syrinx. Surgery after the manifestation of the iatrogenic syrinx resolved the symptoms in 9 patients; in 8 patients, the symptoms partially resolved; and in 1 patient, the symptoms persisted. After surgery addressing the syrinx, it resolved in 5, decreased in size in 10, and remained unchanged in 2 of the patients.
CONCLUSION
Iatrogenic syringomyelia after cranial surgery in pediatric patients occurs mainly after decompressive surgery for Chiari I malformation, shunt surgery, and less frequently following intracranial tumor surgery. Risk factors are postoperative intracranial scarring, shunt malfunction, and mass effect on the foramen magnum. Surgery addressing the iatrogenic syrinx seems to be effective in the majority of the patients in terms of clinical and radiological outcome.
Topics: Adolescent; Arnold-Chiari Malformation; Child; Child, Preschool; Female; Foramen Magnum; Humans; Iatrogenic Disease; Infant; Magnetic Resonance Imaging; Syringomyelia
PubMed: 34156512
DOI: 10.1007/s00381-021-05268-8 -
JAMA Network Open Jul 2020Occult spinal dysraphism (OSD) is the most common congenital spinal anomaly. Cutaneous anomalies such as skin dimples or deviated gluteal folds are well known as... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Occult spinal dysraphism (OSD) is the most common congenital spinal anomaly. Cutaneous anomalies such as skin dimples or deviated gluteal folds are well known as stigmata of OSD and are indicators for further evaluation; however, the association between cutaneous anomalies and OSD has not been systemically evaluated.
OBJECTIVE
To evaluate the incidence of OSD and the proportion of OSD cases managed with a neurosurgical intervention among neonates or infants with various cutaneous stigmata.
DATA SOURCES
PubMed and Embase databases were searched for studies published up to July 25, 2018, that evaluated the proportion of OSD cases in neonates or infants with cutaneous stigmata. Search terms included ultrasound, dysraphism, dimple, and infant or neonate. The search was limited to English-language publications.
STUDY SELECTION
Two reviewers selected the studies evaluating the incidence of OSD among neonates or infants with cutaneous stigmata.
DATA EXTRACTION AND SYNTHESIS
The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for data extraction were followed. Pooled proportions of OSD cases and OSD cases that were managed with a neurosurgical intervention were obtained using the generalized linear mixed model and maximum likelihood method.
MAIN OUTCOME AND MEASURES
The pooled incidence of OSD and OSD cases managed with neurological surgery among patients with cutaneous stigmata was the primary outcome. This outcome was also evaluated in each subgroup, and heterogeneity was explored using subgroup analysis.
RESULTS
A total of 15 studies, involving 6558 neonate or infant patients with various cutaneous stigmata, were included. The pooled proportion of OSD cases among the patients with cutaneous stigmata was 2.8% (95% CI, 2.1%-3.8%; I2 = 51.6%), and the proportion managed with neurological surgery was 0.6% (95% CI, 0.3%-1.3%; I2 = 66.4%). Cases with combined stigmata showed a significantly higher association with OSD than those with a single stigma (10.5% [95% CI, 6.9%-15.8%] vs 2.3% [%, 95% CI, 1.5%-3.5%]; P < .001). The pooled proportion of OSD cases among patients with an atypical dimple was significantly higher than among those with simple dimple (8.8% [95% CI, 4.5%-16.6%] vs 0.6% [95% CI of 1.4%-2.1%]; P = .001).
CONCLUSIONS AND RELEVANCE
The proportion of OSD in healthy, asymptomatic patients with midline cutaneous stigmata was low, and the proportion of patients who underwent a neurosurgical intervention was even lower. However, a careful evaluation as well as potential spinal magnetic resonance imaging is recommended for neonates or infants with combined stigmata or an atypical dimple for possible high-risk lesions.
Topics: Correlation of Data; Humans; Incidence; Infant; Infant, Newborn; Neural Tube Defects; Neurosurgical Procedures; Skin Abnormalities; Spinal Cord
PubMed: 32614421
DOI: 10.1001/jamanetworkopen.2020.7221 -
Neurourology and Urodynamics Jan 2022The purpose of this systematic review was to investigate and synthesize the effects (benefits and harms) of electrical stimulation (EE), alone or in association with...
AIMS
The purpose of this systematic review was to investigate and synthesize the effects (benefits and harms) of electrical stimulation (EE), alone or in association with other interventions, compared with sham and other interventions, for the treatment of neurogenic bladder dysfunction in myelomeningocele.
METHODS
This systematic review was conducted following the methodological recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and registered at PROSPERO (CRD42020200425). A search was performed in the following electronic databases: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, LILACS, and PEDro. Randomized clinical trials (RCTs) that assessed any EE in children diagnosed with myelomeningocele and neurogenic bladder and/or urinary incontinence were included and reported.
RESULTS
When comparing EE versus sham groups, some estimated effects showed a wide confidence interval, probably due to the small sample size of the included studies. This indicates an imprecision in these findings. Regarding the safety of this intervention and safety of the lower urinary tract, no adverse events resulting from EE were reported. All the included studies have evaluated the efficacy of EE compared with sham, but different EE parameters and electrode positions among studies make it impossible to perform a meta-analysis.
CONCLUSIONS
Based on very low certainty evidence, the findings of this systematic review suggested no difference between EE and sham to improve urinary incontinence in children with myelomeningocele. However, the small sample size and the imprecision arising from the wide confidence intervals must be considered. Future RCTs following a rigorous methodology, as recommended by the CONSORT statement, should be conducted to support the use of this intervention in clinical practice.
Topics: Child; Electric Stimulation; Humans; Meningomyelocele; Randomized Controlled Trials as Topic; Urinary Bladder, Neurogenic
PubMed: 34524699
DOI: 10.1002/nau.24792 -
Journal of Orthopaedic Surgery and... Oct 2020This is the first systematic review and meta-analysis on the overall incidence of intraspinal abnormalities in patients with congenital scoliosis (CS) and potential... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This is the first systematic review and meta-analysis on the overall incidence of intraspinal abnormalities in patients with congenital scoliosis (CS) and potential influencing factors.
METHODS
We searched three large electronic databases (PubMed, EMBASE, and Cochrane Library) for potentially relevant studies. The quality of the included studies was assessed independently by two authors using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Data on the number of CS patients, number of CS patients with intraspinal abnormalities, sex of the patients, and CS types were extracted from the included studies. R software was used to pool and analyze all the extracted data.
RESULTS
This meta-analysis included 10 articles, and 671 of 1863 CS patients undergoing magnetic resonance imaging (MRI) examinations were identified to have intraspinal abnormalities. The overall incidence of intraspinal abnormalities in the patients with CS was 37% (95% CI, 29-45%). Diastematomyelia was the most common intraspinal abnormality and was detected in 45.60% of the patients with intraspinal abnormalities (306/671). The remaining intraspinal abnormalities included syringomyelia (273/671, 40.69%), tethered cord (190/671, 28.32%), low conus (58/671, 8.64%), intraspinal mass (39/671, 5.81%), Chiari malformation (32/671, 4.77%), fatty filum (27/671, 4.02%), spina bifida (occulta excluded) (17/671, 2.53%), tumor (17/671, 2.53%), cyst (12/671, 1.79%), syringomyelus (4/671, 0.60%), dural ectasia (1/671, 0.15%), and undiagnosed cord MRI hyperintensity (1/671, 0.15%). The patient's sex and CS type were not factors that affected the incidence of intraspinal abnormalities in CS patients (all P > 0.05).
CONCLUSIONS
This meta-analysis revealed that the overall incidence of intraspinal abnormalities detected by MRI in CS patients was 37%. Diastematomyelia was the most common intraspinal abnormality. The patient's sex and CS type were not factors that affected the incidence of intraspinal abnormalities in CS patients.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Incidence; Magnetic Resonance Imaging; Male; Neural Tube Defects; Scoliosis; Spine; Syringomyelia
PubMed: 33087139
DOI: 10.1186/s13018-020-02015-8 -
Scientific Reports Jan 2023Exposure to low levels of nitrate in drinking water may have adverse reproductive effects. We reviewed evidence about the association between nitrate in drinking water... (Meta-Analysis)
Meta-Analysis
Exposure to low levels of nitrate in drinking water may have adverse reproductive effects. We reviewed evidence about the association between nitrate in drinking water and adverse reproductive outcomes published to November 2022. Randomized trials, cohort or case-control studies published in English that reported the relationship between nitrate intake from drinking water and the risk of perinatal outcomes were included. Random-effect models were used to pool data. Three cohort studies showed nitrate in drinking water is associated with an increased risk of preterm birth (odds ratio for 1 mg/L NO-N increased (OR) = 1.01, 95% CI 1.00, 1.01, I = 23.9%, 5,014,487 participants; comparing the highest versus the lowest nitrate exposure groups pooled OR (OR) = 1.05, 95% CI 1.01, 1.10, I = 0%, 4,152,348 participants). Case-control studies showed nitrate in drinking water may be associated with the increased risk of neural tube defects OR = 1.06, 95% CI 1.02, 1.10; 2 studies, 2196 participants; I = 0%; and OR = 1.51, 95% CI 1.12, 2.05; 3 studies, 1501 participants; I = 0%). The evidence for an association between nitrate in drinking water and risk of small for gestational age infants, any birth defects, or any congenital heart defects was inconsistent. Increased nitrate in drinking water may be associated with an increased risk of preterm birth and some specific congenital anomalies. These findings warrant regular review as new evidence becomes available.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Nitrates; Drinking Water; Premature Birth; Reproduction; Parturition
PubMed: 36631499
DOI: 10.1038/s41598-022-27345-x -
Neurosurgery Sep 2019The incidence of spina bifida (SB) in the developing world is higher than in the United States because of malnutrition and folic acid deficiency during pregnancy....
BACKGROUND
The incidence of spina bifida (SB) in the developing world is higher than in the United States because of malnutrition and folic acid deficiency during pregnancy. Advances in technology have made prenatal repair of myelomeningocele (MM) possible.
OBJECTIVE
The objective of the guidelines are, (1) To create clinical recommendations for best practices, based on a systematic review and analysis of available literature, (2) to obtain multi-disciplinary endorsement of these guidelines from relevant organizations, and (3) to disseminate the educational content to physicians to improve the care of infants with MM.
METHODS
The Guidelines Task Force developed search terms and strategies used to search PubMed and Embase for literature published between 1966 and September 2016. Strict inclusion/exclusion criteria were used to screen abstracts and to develop a list of relevant articles for full-text review.
RESULTS
Guidelines authors aimed to systematically review the literature and make evidence based recommendations about the timing of closure after birth, hydrocephalus, the impact of prenatal closure, and the effect of prenatal closure on ambulation ability and tethered spinal cord. Evidence concerning persistent ventriculomegaly and cognitive impairment was also evaluated. Hundreds of abstracts were identified and reviewed for each of the 5 topics. A total of 14 studies met stringent inclusion criteria.
CONCLUSION
Based on a comprehensive systematic review, a total of 5 clinical practice recommendations were developed, with 1 Level I, 2 Level II and 2 Level III recommendations.The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-1.
Topics: Child; Female; Humans; Infant; Meningomyelocele; Pregnancy; United States
PubMed: 31418038
DOI: 10.1093/neuros/nyz261 -
Nutrients Jun 2022In preconception and pregnancy, women are encouraged to take folic acid-based supplements over and above food intake. The upper tolerable limit of folic acid is 1000 mcg... (Review)
Review
Women Taking a Folic Acid Supplement in Countries with Mandatory Food Fortification Programs May Be Exceeding the Upper Tolerable Limit of Folic Acid: A Systematic Review.
BACKGROUND
In preconception and pregnancy, women are encouraged to take folic acid-based supplements over and above food intake. The upper tolerable limit of folic acid is 1000 mcg per day; however, this level was determined to avoid masking a vitamin B12 deficiency and not based on folic acid bioavailability and metabolism. This review's aim is to assess the total all-source intake of folate in women of childbearing age and in pregnancy in high-income countries with folate food fortification programs.
METHODS
A systematic search was conducted in five databases to find studies published since 1998 that reported folate and folic acid intake in countries with a mandatory fortification policy.
RESULTS
Women of childbearing age do not receive sufficient folate intake from food sources alone even when consuming fortified food products; however, almost all women taking a folic acid-based supplement exceed the upper tolerable limit of folic acid intake.
CONCLUSIONS
Folic acid supplement recommendations and the upper tolerable limit of 1000 mcg set by policy makers warrant careful review in light of potential adverse effects of exceeding the upper tolerable limit on folic acid absorption and metabolism, and subsequent impacts on women's health during their childbearing years.
Topics: Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Food, Fortified; Humans; Neural Tube Defects; Pregnancy; Women's Health
PubMed: 35807899
DOI: 10.3390/nu14132715