Paediatric neurosurgery in Trinidad and Tobago - abstract

ABSTRACT

Neurosurgery in childhood is a distinct branch of neurosurgery. All cases admitted to the paediatric section of the neurosurgical unit in the 5 years from July 1980 to June 1985 were studied retrospectively, to determine the disease pattern and outcome. There were 260 cases with even annual and sex distribution, 40 percent in their first year, 20 percent total newborn, and the rest below the age of 12 years. Eighteen were from other Caribbean territories. There were 214 cranial diagnosis, distributed as congenital, 72; head injury, 76 infection, 12; vascular, 4; tumours, 20, and other, 30. Significant were hydrocephalus, 51; encephalocele, 8; craniosynostosis, 6; depressed skull fracture, 25 acute subdural haematoma, 3; brain stem injury, 8, and cerebral abscess, 3. The tumours were brain stem astrocytoma, 6; cerebral astrocytoma, 5 medulloblastoma, 4; craniopharyngioma, 2, and one each of cerebellar astrocytoma, pineal tumour and ependymoma. There were 63 spinal diagnosis - congenital, 52; injury, 4; tumours, 3 and other, 4. Significant were mylomeningocele, 40, and, in tumours, one each of cervical meningioma, chondrosarcoma and neurofibroma. There were 160 surgical procedures - congenital, 92 trauma, 37infection, 8 vascular, 2 tumours, 19, and others, 2. The most frequent procedures were ventriculo-atrial shunt, 27 ventriculo-peritoneal shunt, 25; shunt revisions, 36; encephalocele repairs, 8; craniosynostosis, 5; release, 3 craniotomies for acute subdural haematoma, 21 fracture elevations, 10 exploratory burr holes, 3 cerebral abscess evacuation, and for tumours, 4 craniotomies, 4 posterior fossa explorations and 7 shunts. In the spinal group, there were 33 myelomeningocele repairs and a cervical meningioma, chondrosarcoma and neurofibroma were removed. Ther were 33 deaths; 21 of these had had surgical procedures. In the total group, 10 were related to congenital defects, 12 were severe head injury, 2 meningitis, 2 ruptured intra-cranial bascular lesions and 6 tumours. The following pertinent factors emerged neural tube defects were noted in the East-Indian in the East-West corridor and Changuanas and in the Afro-Trinidadian in the Belmont-Laventille area. The ventriculoatrial shunt seemed preferable to ventriculo-peritoneal, and the use of 2 separate shunt systems in recurrently malfunctioning shunts was a successful new approach. Head injuries were common and the survival rate unexpectedly good. Spinal fractures were uncommon. Infection had a good prognosis but paediatric brain tumours presented the same dismal picture as it does worldwide (AU)