Abstract
Background: Congenital Myelomeningocele and congenital Hydrocephalus are among the most common pediatric neurosurgery diseases in Libya. This paper elucidates the experience of authors in clinical audit of seventy four cases diagnosed as congenital Myelomeningocele and hydrocephalus, in the period of time (Feb 2017 to Dec 2017). Materials and Methods: This was a prospective study of 74 cases whose data were collected as per the pre-prepared data sheet in a single tertiary Institute in Tripoli (Tripoli Medical Center) from February 2017 and December 2017. Results: Management of 74 patients with complete data was analyzed. Of 74 patients, 20 (27%) patients were isolated MMC, 25 (34%) were isolated HCP, and 29 (39%) occurring in association with MMC. From a total of 74 patients, 34 (45%) were male and 40 (54%) were female. Furthermore, 27 (36%) patients delivered as premature infant and 47 (63%) were full term. The method of delivery was by cesarean section in 69 (93%) cases and by normal vaginal delivery in 5 cases (1%). The prenatal diagnosis of MMC and HCP using ultrasound was established in 70 (94%) cases. Head circumference of all cases at the time of delivery was ranged from 33 to 56 cm. The surgical management of all 74 cases after the diagnosis in our neurosurgical department was as follows: Ventriculoperitoneal (VP) shunts inserted in 63 cases (85%). MMC repair was performed in 38 cases (51%). Most patients 55 (74%) were discharged routinely after VP shunt insertion and MMC repair, while 19 (26%) died in hospital. Further, folic acid intake by dose of (0.4 mg) orally was documented in 31 (41%) pregnant women, and 43 (58%) cases were not taken folic acid. The timing of folic acid intake was after the pregnancy was confirmed in all cases. Conclusion: This review demonstrates a single-institute experience and the current challenges in the management of both MMC and HCP in Libya. The Awareness of the mandatory intake of folic in our society is a national call.
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