Darrag Salim, Awad Elzain Mohammed, Adil Mohamed Alla
Introduction: Neural tube defects are the most common congenital conditions of the nervous system particularly in the African countries like Sudan. Myelomeningocele is the most common form of spina bifida cystica and is associated with lifelong mortalities and morbidities specially when associated with hydrocephalus.
Material and methods: Retrospective review of cases which have been operated at the National Center for Neurological Sciences at Shaab hospital during the period from September 2010 to September 2012. The data obtained from a computerized data record system in the center and the patients clinically assessed by the author when they came for follow up in the refer clinic.
Result: In the last two years the center has received 137 cases having this condition, 55.5% were males and 44.5% were females. The youngest child operated was 4 days old and the oldest was 5473 days which is approximately equivalent to 15 years old. The mean age at presentation was 274 days which is approximately equivalent to 9 months. The most common site of the lesion was in the lumbosacral region (53.3%). The associated hydrocephalus was found in 65.7% of cases. 130 xases improved, 2 were static, 4 deteriorated and one case lost from the follow up.
Conclusion: In our center the placement of ventriculoperitoneal shunt before surgical repair of the defect help to control the secondary effects on brain development and in achievement of solid sustainable repair free from tension and leaks of CSF a major cause of dehiscence of the repair. The presence of cerebral spinal fluid shunting is a major contributor to increased survival of patients with MMC. Tethered cord release can significantly improve symptoms in these patients and reduce the long term effect and complications of this condition. Sometimes the presence of the defect might lessen the tension of hydro-cephalus on the brain this might contribute to delayed presentation and in this case surgical repair of the defect without previous shunting may lead to development of acute hydrocephalus.
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