Management of Myelomeningocele in the Province of Kwazulu-Natal, South Africa
Mnguni, M.N.; Enicker, B.; Madiba, T.E.
South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie 55(2): 73
2017
ISSN/ISBN: 0038-2361 PMID: 28876688 Document Number: 693926
Spina bifida is the most common of congenital anomalies of the central nervous system that are compatible with life. The most frequent form is myelomeningocele. Setting: Neurosurgery Unit, Inkosi Albert Luthuli Central Hospital. Patients: Consecutive children with diagnosis myelomeningocele who were managed at from January 2006 to December 2014. Design: Retrospective analysis of children with myelomeningocele. Multiple logistic regression analysis identified clinical, demographic and surgical variables that were associated with outcome. There were 307 patients of whom 173 were male (57%). One hundred and thirty-five (44%) were delivered via C-section. MMC location was at lumbar [175, 57 %], sacral [21, 7%], thorax [17, 5.5%] and cervical 2 (0.7%). One hundred and fifty-six (51%) presented with CSF leak. One hundred and forty-one (48%) presented with complete paralysis of the lower limbs. The mean age at surgical repair was 4.7 ± 15.6 months. The dura was repaired primarily in all patients and 20 (7.9%) were operated in conjunction with plastic surgeons. Fifty-eight (21%) patients developed wound sepsis of those 35(60%) required surgical debridement, while chemical debridement was sufficient in the rest. The time to wound sepsis was 9.5 ± 3.6 days. Two hundred and eight (68%) children developed hydrocephalus requiring CSF diversion. In 143 (46%) children a VPS was used to treat HCP, while in 27 (9%) ETV was performed, 33 (23%) developed shunt malfunction due to infection [15, 45%]. The time to shunt infection was 176 ± 83.3 days. The in-hospital mortality was 27 (9.1%). Wound sepsis and meningitis were associated with death (p < 0.002). The average hospital stay was 20.4 ± 16.93 days, children with wound sepsis and/or meningitis had longer hospital stay, 38.1 ± 22.3 days and 40.5 ± 29.7 days respectively. Method of delivery, age at repair, CSF leak and hydrocephalus were not independently associated with infection. Infection was associated with adverse outcomes and yielded longer hospital stay.