Related Experiment Videos
Spina bifida cystica: selective management in Zaria, Nigeria
B B Shehu1, E A Ameh, N J Ismail
1Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. ssrs.njsr@skannet.com
Insights
Selective management of spina bifida cystica in Zaria, Nigeria, shows significant postoperative complications and functional disability, highlighting challenges in multidisciplinary care and rehabilitation for affected children.
Area of Science:
- Pediatric Surgery
- Neurology
- Public Health
Background:
- Spina bifida cystica is a complex congenital condition requiring specialized, often multidisciplinary, care.
- Management approaches vary globally, influenced by resource availability and healthcare infrastructure.
- Selective surgical management is practiced in Zaria, Nigeria, for spina bifida cystica.
Purpose of the Study:
- To evaluate the outcomes of selective surgical management for spina bifida cystica in Zaria, Nigeria.
- To identify the types and frequency of postoperative complications.
- To assess the long-term functional disability and rehabilitation challenges in this cohort.
Main Methods:
- Retrospective analysis of 77 children with spina bifida cystica treated operatively over 11 years.
- Data collection included patient demographics, defect type (meningocoele, myelomeningocoele), surgical timing, complications, and follow-up outcomes.
- Assessment of functional disability and rehabilitation status at 3-5 years post-surgery.
Main Results:
- 77 children underwent surgery, predominantly meningocoeles (54) in the lumbosacral region (66).
- 28% experienced postoperative complications (hydrocephalus, wound infection, CSF leakage, meningitis); mortality was 3%.
- Among 32 followed up, 38% had functional disabilities (lower limb weakness, incontinence, hydrocephalus, paralysis), with limited rehabilitation due to poor facilities.
Conclusions:
- Selective management of spina bifida cystica in Zaria results in significant complications and functional handicaps.
- Challenges in multidisciplinary care and rehabilitation hinder adequate patient management.
- Despite selective approaches, comprehensive care for functionally impaired individuals remains a critical challenge.
Abstract:
Management of spina bifida cystica in Zaria, Nigeria is selective. Over a period of 11 years, 77 children with this defect, 54 meningocoeles and 23 myelomeningocoeles, 66 (86%) situated in the lumbosacral region, were treated operatively. Forty-two (55%) had surgery in the neonatal period and 91% within 6 months of birth. Postoperative complications occurred in 19 of 68 patients (28%), including mild hydrocephalus, which resolved spontaneously (six, 9%), wound infection (six, 9%), leakage of cerebrospinal fluid (four, 6%) and meningitis (three, 4%). Mortality was 3% from both meningitis and cardiac arrest. Of 32 patients followed up for 3-5 years, 20 with meningocoeles were normal. Of 12 with myelomeningocoele, four had varying degrees of lower limb weakness, three double incontinence, two faecal incontinence, two had progressive hydrocephalus plus paralysis and double incontinence, and one had urinary incontinence. Therefore, 38% were functionally disabled and could not be adequately rehabilitated owing to poor facilities. While management of spina bifida cystica is more aggressive now in most developed countries, ours remains selective due to difficulty with multidisciplinary care and rehabilitation. Even with our selective management, the care of patients with functional handicap remains a challenge.