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Current status and challenges of neurosurgical procedures for patients with myelomeningocele in real-world Japan

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Abstract

Background

Little is known about the real-world status of neurosurgical treatment of myelomeningocele patients.

Objective

To investigate the real-world status of neurosurgical treatment of myelomeningocele patients, medical claims data provided by the Japan Medical Data Center (JMDC) were analyzed.

Methods

The health claims data of 556 patients with myelomeningoceles from January 2005 to March 2020 were examined. The number of neurosurgical procedures, including myelomeningocele repair, tethered cord release, cerebrospinal fluid (CSF) shunt, CSF drainage, and endoscopic third ventriculostomy (ETV), was determined.

Results

A total of 313 neurosurgical procedures were performed for 135 patients in 74 institutions during the study period. The shunt survival rate was most affected by shunts that were revised when the patient was less than 1 year old, which had a significantly lower survival rate than all of the initial shunts performed when the patient was less than on1 year old; the 1-year shunt survival rate was 35 vs 64% (P = 0.0102). The survival rate was significantly lower in patients younger than 1 year who had CSF drainage before shunting compared to those younger than 1 year who did not have CSF drainage before shunting; the 1-year shunt survival rate was 27 vs 59% (P = 0.0196), and 81% of patients remained free of tethered cord release 10 years later.

Conclusions

In this study, a revised shunt of less than 1 year of age and CSF drainage before shunting were the factors that lowered the shunt survival rate in the real world for CSF shunts for hydrocephalus associated with myelomeningocele.

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Availability of data and material

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

JMDC:

Japan Medical Data Center

CSF:

Cerebrospinal fluid

ETV:

Endoscopic third ventriculostomy

ICD-10:

International Statistical Classification of Diseases and Related Health Problems, 10th Revision

TCR:

Tethered cord release

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Funding

This work was supported by Grants-in-Aid from the Research Committee of CNS Degenerative Diseases, Research on Policy Planning and Evaluation for Rare and Intractable Diseases, Health, Labour, and Welfare Sciences Research Grants, The Ministry of Health, Labour, and Welfare, Japan (20FC1049).

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Authors and Affiliations

  1. Department of Neurosurgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan

    Masahiro Nonaka, Yumiko Komori, Haruna Isozaki, Katsuya Ueno, Takamasa Kamei, Junichi Takeda & Akio Asai

  2. Department of Neurosurgery, Jikei Medical University, Minato-Ku, Tokyo, Japan

    Yuichiro Nonaka

  3. Department of Neurology, Hokkaido University, Sapporo, Hokkaido, Japan

    Ichiro Yabe

  4. Center for Research of the Aging Workforce, University of Occupational and Environmental Health Japan, Kitakyushu, Japan

    Masayoshi Zaitsu

  5. National Hospital Organization, Matsue Medical Center, Matsue, Shimane, Japan

    Kenji Nakashima

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  1. Masahiro Nonaka
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Contributions

Masahiro Nonaka: conception and design of the study, acquisition of data, analysis and/or interpretation of data, drafting of the manuscript, revising the manuscript critically for important intellectual content, approval of the version of the manuscript to be published, Yumiko Komori: analysis and/or interpretation of data, approval of the version of the manuscript to be published, Haruna Isozaki: analysis and/or interpretation of data, approval of the version of the manuscript to be published, Katsuya Ueno: analysis and/or interpretation of data, approval of the version of the manuscript to be published, Takamasa Kamei: analysis and/or interpretation of data, approval of the version of the manuscript to be published, Junichi Takeda: analysis and/or interpretation of data, approval of the version of the manuscript to be published. Yuichiro Nonaka: conception and design of the study, acquisition of data, approval of the version of the manuscript to be published, Ichiro Yabe: conception and design of the study, acquisition of data, approval of the version of the manuscript to be published. Masayoshi Zaitsu: conception and design of the study, acquisition of data, approval of the version of the manuscript to be published, Kenji Nakashima: conception and design of the study, acquisition of data, approval of the version of the manuscript to be published, Akio Asai: analysis and/or interpretation of data, revising the manuscript critically for important intellectual content, approval of the version of the manuscript to be published.

Corresponding author

Correspondence to Masahiro Nonaka.

Ethics declarations

Ethics approval

This study was approved by the Ethics Committee of Kansai Medical University (No. 2021015).

Consent to participate

Written patient consent was waived because data were deidentified.

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The participant has consented to the submission of the report to the journal.

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The authors declare no competing interests.

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Nonaka, M., Komori, Y., Isozaki, H. et al. Current status and challenges of neurosurgical procedures for patients with myelomeningocele in real-world Japan. Childs Nerv Syst 39, 3137–3145 (2023). https://doi.org/10.1007/s00381-022-05613-5

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