Open neural tube defects in neonates: Mode of presentation, challenges, and lessons learnt

Abstract

Background: Management of open neural tube defects is challenging and the outcome is demanding. Aims: The aim of this study was to analyze the outcomes in open neural tube defects. Material and Methods: The data between June 2017 and December 2022 were analyzed. Those with incomplete data, not giving consent, or lost to follow-up were excluded. All underwent closure using primary closure, Z plasty, or rhomboid flap. Dura closure was achieved with native dura augmented with thoracolumbar fascia. The outcome was analyzed with respect to the duration of surgery, blood loss, requirement of Z plasty/rhomboid flaps for closure, wound infection, flap blackening, CSF leak, and features of sepsis. Result: In total, 164 of 243 cases formed the study group. The mean age at presentation was 4 days (range 0–28 days). The mean duration of surgery after presentation was 2 days (range 1–3 days). Mean operating time was 1.15 hours (range 0.45–3.15 h). Hydrocephalous was present in 146 cases and all required VP shunt. Lower limb paraplegia and spasticity were present in 63 and 23 cases. Skin closure was achieved by primary closure in 23, double Z plasty in 76, and rhomboid flap in 65 cases. Wound infection and blackening of flap were seen in 13 and 1 case in double Z pasty and 6 and 7 cases in the rhomboid flap group, respectively (P = 0.7). CSF leak was seen in 8 cases. Wound dehiscence and sepsis were seen in 10 and 28 cases, respectively. Conclusion: Management of open neural tube defects requires adequate planning. CSF shunting and flap/Z plasty is often required.

Keywords

• open neural tube defects
• rhachischisis
• spina bifida
• spina bifida
• z plasty