Surgical management of open spinal dysraphism: 5 years experience in Upper Egypt - a multi-centre study

 

Momen M. Almamoun1, Ali R. Hamdan2, Ahmad Sherif3

                1 Department of Neurosurgery, Faculty of medicine, Sohag University, Sohage, Egypt

                2 Department of Neurosurgery, Faculty of medicine, South Valley University, Qena, Egypt

                3 Department of Neurosurgery, Faculty of medicine, Assiut University, Assiut, Egypt

 

ABSTRACT

 

Objective:  to review the surgical outcome of 60 patients with open spinal dysraphism managed in Upper Egypt, over a period of 5 years.

 

Patients & Methods: This retrospective study includes patients managed for open spinal dysraphism over a period of 5 years (January 2010 - December 2014) in Departments of Neurosurgery at Sohag University Hospital, Qena University Hospital, and Assiut University Hospital.  We reviewed 60 patients regarding their clinical presentation, site and type of lesion, associated congenital anomalies, surgical technique, outcome, and complications.

 

Results: Sixty patients with open spinal dysraphism were included; thirty-seven patients (61.7%) were males while twenty-three patients (38.3%) were females.  Most patients were presented at birth, or shortly after (Fifty-eight), one patient at three months, and one at 1 year. Forty-eight patients had Myelomeningocele (80%), and 12 patients had meningocele (20%). Most common level was Lumbo-sacral in Forty-six cases (76.7%), followed by Lumbar region in nine cases (15%), dorsal in three cases (5%), and two cervical cases (3.3%). Regarding clinical presentation, thirty-eight patients presented with paraplegia (63.4%), eleven patients had weak feet (18.3%), and eleven patients had good leg movements (18.3%). Three patients presented with ruptured sac. In fifty-five patients, primary closure was possible (91.7%), and rotational skin flap was needed for closure in 5 cases (8.3%). Hydrocephalus was present in twenty-seven patients (45%); nineteen patients with concurrent Hydrocephalus (31.7%), and eight patients with post-repair Hydrocephalus (13.3%). Associated congenital anomalies included: equine varus in eighteen patients (30%), kypho-scoliosis in fifteen patients (25%), cardiac anomalies in three patients (5%), and hypospadias in two patients (3.3%). Reported complications were: CSF collection in nine patients (15%), CSF leak in five cases (8.3%), Urine retention and/or abdominal distention in 3 cases (5%), Wound infection and dehiscence in 2 patients (3.3%), and one case of mortality from sleep apnea (1.6%). With follow up, secondary tethered cord occurred in fourteen patients (23.3%), Symptomatic chiari malformation and syringomyelia in three patients (5%), and dermoid cyst in one patient (1.6%).

Conclusion: Spinal dysraphism is still a challenging health problem, especially in developing countries with poor socioeconomic status. Its management requires a multidisciplinary team approach. Aim of surgical management was to prevent further deterioration, control of hydrocephalus or leak from ruptured sac.

 

Key words: Spinal dysraphism, Spina bifida.