Haizel-Cobbina Joseline, Addy Samuel, Obiri-Yeboah Derrick, Darko Kwadwo, Addison Darell A, Still Megan E H, Ampofo Kwaku, Coompson Christian, Bandoh Dickson, Owusu Benedict, Lamina Anthony, Blount Jeffrey P, Johnston James M, Dewan Michael C, Nketiah-Boakye Frank
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA.
Childs Nerv Syst. 2025 Jun 5;41(1):203. doi: 10.1007/s00381-025-06869-3.
Neural tube defects (NTDs) have a high incidence of morbidity and mortality in resource-limited countries. Here, we determine the birth prevalence and describe the presentation, diagnosis, and management of NTDs at Komfo Anokye Teaching Hospital (KATH) in Ghana.
An ambispective study was conducted for all patients presenting to KATH with NTD from 2019 to 2023. Descriptive statistics and geospatial analysis were completed for relevant clinical data including patient demographics, clinical presentation, surgical details, treatment outcomes, and travel distance.
One hundred seventy-one patients presented with NTDs at a median age of 24 days [IQR 6, 113]. Birth prevalence was 4.7 per 1000 births. The majority of patients presented with myelomeningocele (MM) (79%) followed by encephalocele (16%). Surgical repair was performed for 131 (97%) MM cases at a median age of 33 days [IQR: 18-94 days] and for 25 (93%) encephalocele cases at a median age of 183 days [IQR: 41-384 days]. The median post-operative length of stay was 12 days [IQR 6, 22]. The surgical mortality rate was 7% (11/163). 76 (55%) MM patients developed hydrocephalus, of which 24 (32%) underwent CSF diversion at a median interval of 36 days [IQR 21, 143] following MM repair. Follow-up data were available for 158 (92%) patients, with a median follow-up duration of 16 months (IQR: 4-29 months). At the last follow-up, 70% of patients were alive.
Timely and affordable neurosurgical care remains a challenge for NTD patients at KATH and may contribute to elevated morbidity and mortality.
在资源有限的国家，神经管缺陷（NTDs）的发病率和死亡率很高。在此，我们确定了加纳Komfo Anokye教学医院（KATH）神经管缺陷的出生患病率，并描述了其临床表现、诊断和治疗情况。
对2019年至2023年在KATH就诊的所有神经管缺陷患者进行了回顾性队列研究。对包括患者人口统计学、临床表现、手术细节、治疗结果和出行距离在内的相关临床数据进行了描述性统计和地理空间分析。
171例患者患有神经管缺陷，中位年龄为24天[四分位间距6，113]。出生患病率为每1000例出生4.7例。大多数患者表现为脊髓脊膜膨出（MM）（79%），其次是脑膨出（16%）。131例（97%）MM病例在中位年龄33天[四分位间距：18 - 94天]时进行了手术修复，25例（93%）脑膨出病例在中位年龄183天[四分位间距：41 - 384天]时进行了手术修复。术后中位住院时间为12天[四分位间距6，22]。手术死亡率为7%（11/163）。76例（55%）MM患者发生了脑积水，其中24例（32%）在MM修复后中位间隔36天[四分位间距21，143]时接受了脑脊液分流术。158例（92%）患者有随访数据，中位随访时间为16个月（四分位间距：4 - 29个月）。在最后一次随访时，70%的患者存活。
对于KATH的神经管缺陷患者来说，及时且负担得起的神经外科护理仍然是一项挑战，这可能导致发病率和死亡率升高。
