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Spinal dysraphism: experience with 250 cases operated upon
1Department of Neurosurgery, New Children's Hospital, Cairo University, Hospitals, Egypt.
Insights
Surgical outcomes for pediatric spinal bifida lesions in Egypt were unsatisfactory. Early intervention and multidisciplinary care are crucial for improving the quality of life for these children.
Area of Science:
- Pediatric Neurosurgery
- Spinal Dysraphism Management
- Public Health in Egypt
Background:
- A significant number of infants and children in Egypt present with myelodysraphic lesions.
- Socioeconomic factors like poverty, malnutrition, and poor maternal care contribute to the high incidence of these congenital anomalies.
- Many cases are not surgically treated due to severe associated conditions.
Purpose of the Study:
- To summarize the clinical features, diagnosis, and management of spinal bifida aperta (SBA) and spinal bifida occulta (SBO) in children.
- To evaluate the surgical outcomes for pediatric patients with spinal dysraphism.
- To highlight the challenges and suggest future directions for managing these complex cases.
Main Methods:
- Retrospective review of 250 surgically treated children and 313 seen cases over 4 years (1983-1987).
- Comprehensive pre-operative assessment including general, neurological, urological, and orthopedic examinations.
- Diagnostic investigations included plain X-rays, CT scans, spinal myelography, and metrizamide CT scanning.
Main Results:
- 200 cases of SBA and 50 of SBO were analyzed.
- Surgical intervention for SBA was performed as early as possible.
- Surgical outcomes were generally unsatisfactory, particularly for high-level meningomyelocele lesions, failing to produce fully ambulatory, healthy individuals.
Conclusions:
- The surgical results for pediatric spinal bifida in this cohort are not satisfactory.
- Multidisciplinary care and further research are essential to improve outcomes and prevent worsening of the condition.
- Neurosurgeons play a vital role alongside other specialists in managing these handicapped children.
Abstract:
During a period of 4 years (December 1983-December 1987) 250 children were operated upon by the authors. At the outpatient clinic of the New Children's Hospital 313 infants and children suffering a myelodysraphic lesion were seen, 63 of whom were not treated surgically owing to the presence of severe hydrocephalus in 16 cases and complete flaccid paraplegia with marked sphincteric disturbances in 47. All of the patients came from poor families. Malnutrition, many siblings per family, poor maternal care, and repeated pregnancies and abortions have added to the large incidence of such a handicap in Egypt. The clinical features, diagnosis, and management of 200 cases of spinal bifida aperta (SBA) and 50 of spina bifida occulta (SBO) are summarized. SBA cases were operated upon as soon as possible from the time of their presentation; their preliminary assessment included an exhaustive general, neurological, urological, and orthopedic examination; and investigations such as plain X-rays to the back and skull, CT scanning of the cranium, spinal myelogram, and metrizamide CT scanning to the back were performed. The surgical outcome is far from being satisfactory in the sense of producing an ambulatory, intelligent, healthy individual, especially in a meningomyelocele patient having a high-level lesion. The authors believe that there is still much to be done for these children marked by fate, and the neurosurgeon should be one among several other physicians devoted to the amelioration or at least the prevention of worsening, if possible, of the condition in such unfortunate and handicapped children.