Late repair in myelomeningoceles: initial experience in a single sub-Saharan center
Keywords:
myelomeningocele, late repair, open spina bifida.Abstract
Introduction: Myelomeningocele is the most common form of spinal dysraphism. In the African context, late diagnosis and surgical treatment are frequent.
Objective: To characterize an initial series of open myelomeningocele cases that received delayed repair at the Hôpital de Référence de Maradi.
Methods: A series of five cases is presented, with open myelomeningocele, who received delayed surgical repair at the Hôpital de Référence de Maradi, Niger, between June - December 2022. The information was obtained from medical records and imaging records.
Results: Five patients were intervened, three female and two male. In all cases the age of the patients at the time of surgery was greater than 30 days. All the dysraphisms were open, showing signs of partial or total epithelialization of the placode, at the time of the intervention. During the evaluation of neurological function, three of them exhibited distal paraplegia, with reflex and sphincter involvement. Laboratory tests showed, in all cases, hemoglobin levels below 12 mg/dl. None of the cases showed deterioration of the neurological state with respect to the preoperative evaluation.
Conclusions: The surgical treatment of myelomeningocele in a low-resource setting, as is common in sub-Saharan Africa, has its own characteristics, marked by late presentation to specialized hospital centers, and the low nutritional status of patients. Surgical resection, partial or total, of an exposed and devitalized placode, with signs of epitalization, does not seem to influence the postoperative neurological status.
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