Myelomeningocoele in Nigeria: Has There Been Any Change with Improved Neurosurgery Care?

Ephraim Onyia, Mark Chikani, Wilfred Mezue, Enoch Uche, Izuchukwu Iloabachie, Matthew Mesi, Emeka Okorie

Abstract


A 6 year retrospective study of the clinical and pathological profile of myelomeningoceles who had neurosurgical care at the neurosurgical unit of the University of Nigeria Teaching Hospital Enugu, South-East Nigeria from 2010-2015 was done. The review found 57 males (54.2%) and 47 females (45.8%). Patients age ranged from 1 day to 7 years. More patients (59.6%) presented outside the neonatal age group. Fifty patients (48.1%) live in urban setting while 54 (51.9%) were from a rural setting. The lumbo-sacral area is the most common location, followed by thoraco-lumbar, sacral, and the thoracic regions representing 90.4%, 5.8%, 2.9%, and 1% respectively. Associated anomalies were seen in 57 patients (54.8%) with neurologic abnormalities been the most common (49% of all cases) followed by hydrocephalus (44.2%). Limb paralysis was above L2 in 45.1%. There is an association between increasing paternal age and presence of associated abnormalities (p = 0.027). Significant association was also found between place of residence and associated anomalies (p 0.009).Surgical procedures were performed in 84 patients (80.8%). The postoperative mortality was 5.9%. Ignorance of pre-conception folic acid use was demonstrated. Ante-natal preventive strategies need to be reviewed, while multi-disciplinary management with good social support is recommended post-natally.


Keywords


Myelomeningocoele; Folic acid; Limb paralysis.

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References


R. M. Bowman and D. G. McLone, Neurological Management of Spina Bifida: Research Issues, Dev. Disabil. Res. Rev., vol. 16, no. 1, pp. 8287, 2010.

M. S. Dias, Neurosurgical Management of Myelomeningocele (Spina Bifida), Pediatr. Rev., vol. 26, no. 2, pp. 5060, 2005.

N. S. Adzick, Fetal myelomeningocele: Natural history, pathophysiology, and in-utero intervention, Semin. Fetal Neonatal Med., vol. 15, no. 1, pp. 914, 2010.

J. Lober, Early Results of Selective Treatment of Spina Bifida Cystica., Br. Med. J., vol. 4, pp. 201204, 1973.

J. Lorber, Spina bifida cystica. Results of treatment of 270 consecutive ca, Arch. Dis. Child., vol. 47, no. 256, pp. 85473, 1972.

L. J. Pruitt, Living with spina bifida: a historical perspective., Pediatrics, vol. 130, no. 2, pp. 1813, 2012.

D. Poenaru and N. Bauman, Neurodisability, in Paediatric Surgery: A Comprehensive Text for Africa, 1st ed., E. A. Ameh, S. W. Brickler, K. Lakhoo, and D. Poenaru, Eds. Seattle: Global HELP, 2011, pp. 699708.

D. Nnadi and S. Singh, The prevalence of neural tube defects in North-West Nigeria -, Saudi J Heal. Sci, vol. 5, pp. 610, 2016.

A. F. Uba, E. S. Isamade, L. B. Chirdan, S. T. Edino, M. E. Ogbe, and G. O. Igun, Epidemiology of Neural Tube Defects in North Central Nigeria, vol. 1, no. 1, pp. 1619, 2004.

J.-K. C. Emejulu, C. Osuafor, and C. N. Ogbuagu, Audit of the demographic patterns of neurosurgical cases in a tertiary health institution: the need to relate service delivery to disease profile in dwindling resources and manpower shortage, African J. Neurol. Sci., vol. 28, no. 2, pp. 1121, 2009.

W. C. Mezue and C. B. Eze, Social Circumstances Affecting the Initial Management Of Children With Myelomeningocele in Nigeria, Dev. Med. Child Neurol., vol. 34, no. 4, pp. 33841, 1992.

G. D. Stark, Neonatal Assessment of the Child with a Myelomeningocele, Arch. Dis. Child., vol. 46, pp. 539548, 1971.

N. P. C. D. 2016 population and housing census. N. and S. P. and H. T. 2016 Online, No Title National Population Commission. 2016. Available: http://www.population.gov.ng/

W. C. Mezue and C. B. Eze, SOCIAL CIRCUMSTANCES AFFECTING THE INITIAL MANAGEMENT O F CHILDREN WITH MYELOMENINGOCELE IN NIGERIA, no. 1971, 1973.

P. O. Eghwrudjakpor, S. O. Wokocha, and A. Eneh, Predicting Outcome Following Surgery For Myelomeningocele: A UPTH Experience, Niger. J. Clin. Pract., vol. 5, no. 2, pp. 103105, 2002.

M. M. Mweshi, S. L. Amosun, M. P. Shilalukey-Ngoma, and E. Munalula-Nkandu, Ethnic Pattern of Origin of Children with Spina Bifida Managed at the University Teaching Hospital and Beit Cure Hospital, Lusaka, Zambia 2001-2010, Sci. J. Public Heal., vol. 3, no. 6, pp. 857861, 2001.

B. B. Shehu, Repair of Myelomeningocele : How I Do It ., October, vol. 1, no. 1, pp. 4247, 2009.

I. O. Nnamdi, Myelo-meningocele; A multi-disciplinary problem, Niger. Med. J., vol. 55, pp. 736, 2014.

L. I. Audu, B. B. Shehu, I. J. Thom-Manuel, and A. B. Mairami, Open Neural Tube Defects at the National Hospital, Abuja: an Analysis of Clinical Patterns and Neonatal Outcome, Niger. J. Paediatr., vol. 31, no. 4, pp. 131136, 2004.

B. B. Shehu, E. A. Ameh, and N. J. Ismail, Spina bifida cystica: Selective management of Zaria, Nigeria, Annals of Tropical Paediatrics, vol. 20, no. 3. pp. 239242, 2000.

G. Talamonti, G. DAliberti, and M. Collice, Myelomeningocele: long-term neurosurgical treatment and follow-up in 202 patients, J. Neurosurg. Pediatr., vol. 107, no. 5, pp. 368386, 2007.

D. N. P. Thompson, Postnatal management and outcome for neural tube defects including spina bifida and encephalocoeles, Prenat Diagn, vol. 29, pp. 412419, 2009.

M. S. Greenberg, Handbook of Neurosurgery, 8th Editio. New York: Thieme Publishers, 2016.

A. E. Czeizel and I. Dudas, Prevention of the First Occurrence of Neural Tube Defects by Periconceptional Vitamin Supplementation, N. Engl. J. Med., vol. 327, pp. 18325, 1992.

MRC VITAMIN STUDY RESEARCH GROUP, Prevention of neural tube defects: Results of the Medical Research Council Vitamin Study, Lancet, vol. 338, no. 8760, pp. 131137, 1991.

E. J. Wright, Myelomeningocele And Hydrocephalus In Uganda : The Intersection Of Culture , Supportive Care , And Long-Term Survival, Yale, 2011.


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