Giant Encephalocele in Sokoto, Nigeria: A 5-Year Review of Operated Cases
Part of the content of this article was presented at the 2nd Continental Association of African Neurosurgical Societies (CAANS) continental congress July 2015. The first author was one of the recipients of the CAANS Scholarship award to attend the congress in Cape Town.
Author links open overlay panelGyang MarkusBot12Nasiru J.Ismail1Muhammad RajiMahmud13IsmailHassan14AliLasseini1Danaan J.Shilong12Joseph O.Obande15BabaganaUsman16Lena MaryHoulihan7Mark C.Preul7Bello B.Shehu1
1
Department of Neurosurgery, Regional Centre for Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2
Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
3
Department of Surgery, National Hospital Abuja, Abuja, Nigeria
4
Department of Surgery, Aminu Kano University Teaching Hospital, Kano, Nigeria
5
Department of Surgery, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
6
Department of Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
7
Department of Neurosurgery, Barrow Neurological Institute, St. Jospeh's Hospital and Medical Centre, Phoenix, Arizona, USA
Received 15 October 2019, Accepted 11 March 2020, Available online 19 March 2020.
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Objective
Encephalocele is a common congenital malformation of the central nervous system; however, giant encephaloceles are rare. The use of folic acid supplementation and termination of pregnancies, which are prenatally diagnosed with encephaloceles and other congenital malformation of the central nervous system, has significantly reduced the occurrence of this type of congenital malformation, especially in developed countries.
Methods
This was a retrospective review over a 5-year period from January 2006 to December 2010 at the Department of Neurosurgery, Regional Centre for Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. The records of patients with giant encephalocele were retrieved from the case notes of patients who had excision and repair for encephalocele.
Results
Seventy-three patients had excision and repair of encephalocele over the study period. However, the records of only 50 patients were retrieved. Fourteen (28%) of the 50 whose records were retrieved had giant encephalocele. There were 4 male and 10 female patients (1:2.5). Thirteen (92.9%) had the lesion located in the occipital region, whereas in 1 patient (7.1%) the lesion was at the vertex. Three (21%) of the cases had microcephaly, 1 (7.1%) had macrocephaly, and 1 (7.1%) developed postoperative hydrocephalus. The average size of defect was 2.43 cm, and the size of the lesion ranged from 12 × 6 cm to 40 × 50 cm. The average maternal age was 20.3 years (n = 6), and the paternal age was 29 years (n = 4). Four out of 7 (57%) mothers had febrile illness in early pregnancy. Seven out of 10 patients (70%) did not have antenatal care.
Conclusions
This condition is more common in children conceived during the period when farm products are yet to be harvested, and whose mothers did not attend antenatal care visits. It is recommended that mothers should be educated on the necessity of preconception folic acid. Implementation of a national strategy on food fortification is also advised. We recommend surgery after the first month of life to reduce poor early postoperative outcomes. In developing countries and centers with suboptimal pediatric intensive care units, surgical intervention is preferred after the first month of life with good temperature control, adequate fluid replacement following rupture of the sac, blood transfusion availability, and, only if necessary, complex cranial reconstruction.
Part of the content of this article was presented at the 2nd Continental Association of African Neurosurgical Societies (CAANS) continental congress July 2015. The first author was one of the recipients of the CAANS Scholarship award to attend the congress in Cape Town.
Author links open overlay panelGyang MarkusBot12Nasiru J.Ismail1Muhammad RajiMahmud13IsmailHassan14AliLasseini1Danaan J.Shilong12Joseph O.Obande15BabaganaUsman16Lena MaryHoulihan7Mark C.Preul7Bello B.Shehu1
1
Department of Neurosurgery, Regional Centre for Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2
Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
3
Department of Surgery, National Hospital Abuja, Abuja, Nigeria
4
Department of Surgery, Aminu Kano University Teaching Hospital, Kano, Nigeria
5
Department of Surgery, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
6
Department of Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
7
Department of Neurosurgery, Barrow Neurological Institute, St. Jospeh's Hospital and Medical Centre, Phoenix, Arizona, USA
Received 15 October 2019, Accepted 11 March 2020, Available online 19 March 2020.
crossmark-logo
Show less
https://doi.org/10.1016/j.wneu.2020.03.061Get rights and content
Objective
Encephalocele is a common congenital malformation of the central nervous system; however, giant encephaloceles are rare. The use of folic acid supplementation and termination of pregnancies, which are prenatally diagnosed with encephaloceles and other congenital malformation of the central nervous system, has significantly reduced the occurrence of this type of congenital malformation, especially in developed countries.
Methods
This was a retrospective review over a 5-year period from January 2006 to December 2010 at the Department of Neurosurgery, Regional Centre for Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. The records of patients with giant encephalocele were retrieved from the case notes of patients who had excision and repair for encephalocele.
Results
Seventy-three patients had excision and repair of encephalocele over the study period. However, the records of only 50 patients were retrieved. Fourteen (28%) of the 50 whose records were retrieved had giant encephalocele. There were 4 male and 10 female patients (1:2.5). Thirteen (92.9%) had the lesion located in the occipital region, whereas in 1 patient (7.1%) the lesion was at the vertex. Three (21%) of the cases had microcephaly, 1 (7.1%) had macrocephaly, and 1 (7.1%) developed postoperative hydrocephalus. The average size of defect was 2.43 cm, and the size of the lesion ranged from 12 × 6 cm to 40 × 50 cm. The average maternal age was 20.3 years (n = 6), and the paternal age was 29 years (n = 4). Four out of 7 (57%) mothers had febrile illness in early pregnancy. Seven out of 10 patients (70%) did not have antenatal care.
Conclusions
This condition is more common in children conceived during the period when farm products are yet to be harvested, and whose mothers did not attend antenatal care visits. It is recommended that mothers should be educated on the necessity of preconception folic acid. Implementation of a national strategy on food fortification is also advised. We recommend surgery after the first month of life to reduce poor early postoperative outcomes. In developing countries and centers with suboptimal pediatric intensive care units, surgical intervention is preferred after the first month of life with good temperature control, adequate fluid replacement following rupture of the sac, blood transfusion availability, and, only if necessary, complex cranial reconstruction.
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