Neonatal Giant and Open Neural Tube Defects: Challenges and Lesions Learnt

Abstract

Abstract Background: Management of large/open neural tube defects (NTDs) is challenging and outcome is demanding. Aims: To analyze the outcomes in giant NTDs. Materials and Methods: The data between June 2017 and September 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 thoracolumber fascia. The outcome was analyzed with respect to duration of surgery, blood loss, requirement of Z plasty for closure, wound infection, blackening of the flaps, cerebrospinal fluid leak, and features of sepsis. Result: 164 out of 243 cases formed the study group. Mean age at presentation was 4 days (range 0–28 days). Mean duration of surgery was 2 days (range 1–3 days). Mean operating time was 1.15 hours (range 0.45–3.15 hours). Hydrocephalous was present in 146 cases and all required ventriculo peritoneal 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 plasty and 6 and 7 cases in rhomboid flap group, respectively (P = 0.7). cerebrospinal fluid leak was seen in 8 cases. Wound dehiscence and sepsis were seen in 10 and 28 cases, respectively. Conclusion: Management of large defect requires adequate planning. cerebrospinal fluid shunting and flap/Z plasty are often required.