{Reference Type}: Journal Article
{Title}: The Importance of Neurosurgical Intervention and Surgical Timing for Management of Pediatric Patients with Myelomeningoceles in Bangladesh.
{Author}: Mukherjee SK;Papadakis JE;Arman DM;Islam J;Azim M;Rahman A;Ekramullah SM;Suchanda HS;Farooque A;Warf BC;Mazumdar M;
{Journal}: World Neurosurg
{Volume}: 187
{Issue}: 0
{Year}: 2024 Jul 27
{Factor}: 2.21
{DOI}: 10.1016/j.wneu.2024.04.144
{Abstract}: <B>OBJECTIVE: </B>Reports on the management and survival of children with myelomeningocele defects in Bangladesh are limited. This study describes the characteristics and outcomes of these children, focusing on the timing of surgical repair and factors affecting survival.<BR><B>METHODS: </B>We enrolled patients with myelomeningoceles in a case-control study on arsenic exposure and spina bifida in Bangladesh. Cases were subsequently followed at regular intervals to assess survival. Demographic, clinical, and surgical characteristics were reviewed. Univariate tests identified factors affecting survival.<BR><B>RESULTS: </B>Between 2016 and 2022, we enrolled 272 patients with myelomeningocele. Postnatal surgical repair was performed in 63% of cases. However, surgery within 5 days after birth was infrequent (<10%) due to delayed presentation, and there was a high rate (29%) of preoperative deaths. Surgical repair significantly improved patient survival (P < 0.0001). Older age at time of surgery was also associated with improved survival rates, which most likely represents that those who survived to older ages prior to surgery accommodated better with their lesions. Patients who presented with ruptured lesions had lower survival rates.<BR><B>CONCLUSIONS: </B>Timely neurosurgical repair of myelomeningoceles in Bangladesh is hindered by late patient presentation, resulting in a high preoperative patient death rate. Neurosurgical intervention remains a significant predictor of survival. Increased access to neurosurgical care and education of families and non-neurosurgical providers on the need for timely surgical intervention are important for improving the survival of infants with myelomeningoceles.