Spinal dysraphism: experience with 250 cases operated upon.

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.