Online ISSN: 2515-8260

Keywords : Spinal dysraphism


A study of clinical profile and surgical outcome of spinal dysraphism in paediatric population an institutional study

Dr. Vishwanath Sidram, Dr. Chandrakumar PC, Dr. Biradarpatil Basavaraj, Dr. SV Sreeharsha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 913-921

Aims: To study the surgical outcome in paediatric patients presenting with spinal dysraphism
in our institution.
Materials and Method: 78 paediatric cases presented between 2014 to 2019 with
myelomeningocele to the neurosurgical OPD in Vijayanagara Institute of Medical Sciences,
Ballari which caters to mainly rural and semi urban population. Initial clinical assessment,
followed by operative work up was done. MRI Brain and spine was done as a prep operative
evaluation. Post-operative outcome was noted and Post-operative regular follow up after
discharge for at least 6 months.
Results: 78 patients were operated upon at our centre. The mean age of presentation of the
cases 5 months +/- 6 days, ranging from 8days to 24months. Post-operative average hospital
stay was 14 days. The mean post-operative follow up period was 36 months. Hydrocephalus
was associated with meningomyelocele in 30 cases, but VP shunting required in same sitting
in 9 cases only. Six patients found to have CSF leak and only 1 required reexploration and
Dural repair.
Conclusion: The clinical profile of patients presenting to us mirror the General profile across
India. Surgical outcomes at our center are on par with the standard results seen across the
country. Early and prompt surgical intervention is the key in management of spinal
dysraphism. The MOMS study comparing surgical outcomes with pre natal surgery shows
equivalent outcomes with post natal surgery

A Study on the Incidence, Clinical Presentations, and Surgical Outcome in Spinal Dysraphism Patients

K. Indu Sekhar, Banaka Ravi Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1940-1954

Background: Spinal dysraphism is common congenital cause of disability in children
encountered by pediatric neurosurgeon and is a significant public health problem. Open
type spina bifida is more common than closed one. Though most of these cases are
diagnosed at birth or at an early infancy, some may be discovered in older children or
in adults. Aim & Objective: Our aim is to study the incidence, clinical presentations,
and surgical outcome in spinal dysraphism patients. Clinically patients are assessed on
the basis of history, presenting symptoms and neurological examination.
Results: A total of 54 patients included in this study. The age ranged from 1day to 17
years. The incidence is high in females 57.40 % (n=31) than males 42.60 % (n=23). The
swelling over the middle of the back was most common manifestation present in
32(59.2%) cases out of total 54 cases. 8 patients (14.81%) had ruptured
myelomenigocele/ myelocele sac. The skin markers which occur in spina bifida occult
type like dermal sinus, Hypertrichosis, dimple of skin present in 3(5.55%), 2(3.70%),
1(1.85%) respectively. Craniospinal MRI was done in all patients for evaluation of
congenital anomalies associated with spinal dysraphism. All were having one or
multiple anomalies. Spina bifida aperta (37) was more common than bifida occulta
which is noted in17 patients. Most common finding is myelomeningocele in 33 (61.11%)
cases, myelocele 4 (7.47%). In closed type, lipomyelomeningocele 7(12.96%) was most
common finding, and meningocele 3(5.55%), lipomyelocele 2(3.70%), diastematomyelia
in 2((3.70%), dermal sinus 2(3.70%), spinal lipoma in one (1.85%) case.Most of the
patients associated with hydrocephalus require shunt surgery prior to the definitive
surgery.The post operative care is equally important to avoid complications and for
better outcome. Electro myographic studies and urodynamic studies are required to
assess the sphincteric outcome following surgery. Pain is common symptom to improve.
Motor deficits improve better than sensory deficits and bladder dysfunctions post
operatively.Outcome of these patients are always at risk of retethering and delayed
neurological deterioration.
Conclusion: Therefore, close monitoring by a multidisciplinary team is important.
Inadequate treatment at peripheral centres should be avoided. Spinal dysraphism
patients should be referred to higher tertiary centre where the complete team is
available.