Washington University in St. Louis (WU)
Myelomeningocele (MMC), where the spinal cord and the meninges are extruded outside of the vertebral canal into a sac filled with cerebrospinal fluid, is the most common congenital CNS abnormality and often results in lifelong disability. Prenatal MMC repair reduces hydrocephalus rates and decreases disability relative to postnatal surgery. Hydrocephalus is traditionally treated with ventriculoperitoneal shunting (VPS), which is associated with significant morbidity including infection and overdrainage. An emerging alternative with fewer apparent complications is endoscopic third ventriculostomy (ETV). However, the efficacy of ETV versus VPS and the optimal timing for VPS in MMC patients, particularly following prenatal versus postnatal repair, is not understood. Additionally, there is poor understanding of brain growth and connectivity in MMC. My research aims to understand optimal timing for hydrocephalus treatment, the efficacy of ETV versus VPS, and differences in brain structure and functional connectivity in patients following prenatal and postnatal MMC repair.