ABSTRACT
Background. Spina bifida (SB) is a neural tube defect (NTD) that has an increased risk of fatal and disabling effects if not repaired early, i.e. within the first 24 to 48 hours of life. Its diagnosis holds an increased burden for the patient and the caregiver owing to secondary complications. The effects of the disease are detrimental even with early repair, because of the long-term disabling nature of the disease.Objective. This retrospective study aimed to assess the effects of demographics, immediate post-surgical complications and impact of time to surgical intervention on the outcome of neonates with open SB (OSB) admitted to the neonatal intensive care unit (NICU) at Inkosi Albert Luthuli Central Hospital (IALCH) in KwaZulu-Natal, South Africa (SA), between January 2011 and December 2015.Methods. A retrospective chart review was conducted at the NICU of IALCH. All neonates diagnosed with SB were identified. The study period was from 1 January 2011 to 31 December 2015. Data were collected from the IALCH electronic database. All neonates with SB admitted to the IALCH NICU were included; any patient who presented beyond the neonatal period (i.e. >28 days) was excluded from the study. Data collected included maternal demographics. Additionally, neonatal history was reviewed and post surgery complications evaluated. Outpatient management post discharge was reviewed.Results. One hundred and fifty neonates were included (58% male). The mean (standard deviation) maternal age was 26.7 (6.6) years. Only 10% had an antenatal diagnosis of OSB. Seventy-eight percent were born at term and 22% prematurely. The lumbar/sacral region was the most commonly affected. More males (14%) had thoraco/lumbar lesions than females (7.8%). Forty-eight percent presented before 3 days of life (early presentation). In the late-presentation group, there was an association with wound sepsis (p=0.003). Twenty-five percent were repaired between days 0 and 3 of life and 75% after 3 days. Postoperative complications in patients whose open SBs were repaired beyond 3 days of life were not statistically significant compared with those with early repair; all were p>0.05. There was a borderline association of prolonged hospitalisation with wound sepsis (p=0.07). Long-term outcomes showed that 68% had lower limb dysfunction, 18% urological complications, 14% limb deformity, and 11% hydrocephalus. A minority had psychomotor (7%) and developmental (15%) disorders. Ten percent required readmission secondary to shunt complications, and 7% died. Conclusion. SB remains a significant disease burden that affects outcome and survival of neonates in SA. Lack of good antenatal care, which includes early ultrasound and timely referral to centres, are barriers to good outcomes. Long-term follow-up is also necessary to prevent morbidity
Subject(s)
Infant, Newborn , Neural Tube Defects , Neurosurgical Procedures/complications , Neurosurgical Procedures/epidemiology , Neurosurgical Procedures/methods , South Africa , Spinal DysraphismABSTRACT
Objectif: Présenter et discuter les résultats de l'activité neurochirurgicale au Centre Hospitalier Régional Lomé Commune.Patients et Méthode:Nous avons mené une étude rétrospective de Juillet 2014 à Juillet 2016, incluant les patients opérés pour une affection neurochirurgicale. Les paramètres étudiés étaient épidémio- logiques, diagnostiques, chirurgicaux et évolutifs. Résultats:Cent quatre-vingt-douze patients ont été opérés. Leur âge moyen était de 42,14 ans [0-72]. Le sex ratio étaitde 1,94 en faveur des hommes. La durée moyenne du séjour hospitalier en post opératoire était de 8,2 jours. Les affections dégénératives du rachis ont été la première pathologie concernée par la chirurgie (49,48%), suivies des traumatismes du rachis (17,19%). L'évolution a été favorable dans 90,1% des cas, pour l'ensemble de la série. Nous avons noté 1,6% de cas d'infection du site opératoire, sur l'ensemble de la série. Conclusion : Les résultats sont encourageants pour l'ensemble de la série. L'essor de la pratique neurochirurgicale au Togo nécessite la création d'unités neurochirurgicales indépendantes, une amélioration du plateau technique et une coopération multidisciplinaire
Subject(s)
Neurosurgical Procedures/instrumentation , Neurosurgical Procedures/methods , Retrospective Studies , TogoABSTRACT
Background: Neurosurgical services have only been introduced in Rwanda recently. Consequently little information about spectrum of neurosurgical conditions in th country is available. This descriptive prospective study was aimed at determining the pattern; causes and outcome of management of neurosurgical conditions seen in Butare University Teaching Hospital (BUTH) in Rwanda. Methods: The study population consisted of 152 patients admitted at BUTH with neurosurgical conditions between October 1 2007 and May 31 2008. Patients were grouped into different neurosurgical conditions according to their clinical presentations. . Information collected included age; gender; cause and severity of injury; the time interval between injury Glasgow Coma Score; GOS scales were used to assess head injured patients. Results: The majority (70.4) of patients came from rural areas. Their ages ranged from 15 days to 78 years with a mean of 31.98+/-18.75 years. The Male to female sex ratio was 2:1. Most (73.0) of the patients suffered from trauma with 67.6of them sustaining head injury and 32.4; spinal trauma. Motor Vehicle crashes were the major cause of traumatic injuries (20in spinal trauma and 70.7of head trauma). Only 23of the patients had CT scan performed. Only 12of patients with traumatic brain injury (TBI) had CT scan.. A total of 78.7of all head injuries were admitted in the first 24 hours following trauma. A significant number (44.4) of spinal cord injury presented late (up to 7 days before referral to a neurosurgeon) and stayed longer in the hospital (52.7up to 3 months). Laminectomy and fixation was the most common spinal operative procedure (58.7) followed by discectomy (34.8). The commonest cranial operation was for posttraumatic intracranial haemorrhage (41.4) followed by surgery for depressed fracture (37.9). One child had a shunt procedure for hydrocephalus. Good recovery was associated with GCS 13 on admission (P0.001). The overall mortality rate was 13.2. The mortality among patients admitted with GCS 8 was 52.4. Conclusion: Neurological injuries were the most commonly seen conditions mainly in head injuries. This study confirms that neurosurgical procedures can still be done with fair results using very little equipment. Providing basic equipment to national neurosurgeons; however; and training them to work in an adverse environment remains a big challenge