Incidence of Development of Hydrocephalus after Excision and Repair of Spina Bifida Aperta in Infants


  • Hassaan Zahid
  • Lubna Ijaz
  • Amna Malik
  • Laeeq Ur Rehman
  • Malik M
  • Nadeem Khan



Objective:  To find out the incidence of hydrocephalus after excision and repair in infants presenting with Spina Bifida Aperta.

Materials & Methods:  This prospective cohort study was conducted at the Pediatric Neurosurgery Department, Children Hospital & The Institute of Child Health, Lahore, Pakistan, from January 2021 to October 2021. A total of 62 infants of both genders presenting with spina bifida Aperta undergoing repair were included. Data of the patients, i.e., name, age, gender, head circumference, location, and width of the defect, accompanying bladder, limb anomalies, radiological, laboratory findings, and diagnosis (meningocele or meningomyelocele) were noted. Patients were followed postoperatively for 1-month, and the incidence of post-surgery hydrocephalus was noted.

Results:  Out of 62 children, 36 (58.1%) were male and 24 (41.9%) female. The mean age was noted to be 138.82 days. Most children, 36 (58.1%), were found to have meningocele. The most frequent local meningocele/meningomyelocele was noted to be lumbosacral, 22 (35.5%). Post-surgery hydrocephalus was noted among 11 (17.1%) cases. No significant association of gender, age, head circumference, defect size, the maximum dimension, diagnosis (meningocele or meningomyelocele), or location was noted with post-surgery hydrocephalus among study cases (p > 0.05). No mortality was reported.

Conclusion:  Meningomyelocele and lumbosacral location of the defect were among the prominent factors affecting the incidence of post-surgery hydrocephalus.

Keywords:  Spina Bifida Aperta, Meningiocele, Myelomeningocele, hydrocephalus, lumbosacral


Lien SC, Maher CO, Garton HJ, Kasten SJ, Muraszko KM, Buchman SR. Local and regional flap closure in myelomeningocele repair: a 15-year review. Child's Nervous System, 2010; 26 (8): 1091-5.

Khattak ST, Khan M, Naheed T, Ismail M. Prevalence and management of anencephaly at Saidu Teaching Hospital, Swat. J Ayub Med Coll Abbottabad, 2010; 22 (4): 61-3.

Qazi G. Relationship of selected prenatal factors to pregnancy outcome and congenital anomalies. J Ayub Med Coll Abbottabad, 2010; 22 (4): 41-5.

Kankaya Y, Sungur N, Aslan ÖÇ, Ozer K, Ulusoy MG, Karatay M, et al. Alternative method for the reconstruction of meningomyelocele defects: VY rotation and advancement flap. J Neurosurg Pediatr. 2015; 15 (5): 467-74.

Rehman L, Shiekh M, Afzal A, Rizvi R. Risk factors, presentation and outcome of meningomyelocele repair. Pak J Med Sci. 2020; 36 (3): 422.

Ghani F, Ali M, Azam F, Ishaq M, Zaib J. Risks of surgery for myelomeningocele in children. Pak J of Neurol Surg. 2016; 20 (1): 53-7.

Kellogg R, Lee P, Deibert CP, Tempel Z,

Zwagerman NT, Bonfield CM, et al. Twenty years' experience with myelomeningocele management at a single institution: lessons learned. J Neurosurg Pediatr. 2018; 22 (4): 439-43.

Bashir MK, Ishtiaq A, Javeed A. Correlation of Neurological Deficits in Patients with Myelomeningocele on the Basis of Anatomical Location and Size of Base of Defect. National J Health Sci. 2020; 5 (1): 19-23.

Nethi S, Arya K. Meningocele. Stat Pearls. Treasure Island (FL): Stat Pearls Publishing Copyright © 2020, Stat Pearls Publishing LLC.; 2020.

Khan A. Outcome of Myelomeningocele Repair and Early Postoperative Complications. Pak J of Neurol Surg. 2018; 22 (4): 200-5.

Spoor JKH, Gadjradj PS, Eggink AJ, DeKoninck PLJ, Lutters B, Scheepe JR, et al. Contemporary management and outcome of myelomeningocele: the Rotterdam experience. Neurosurg Focus, 2019; 47 (4): E3.

Tarcan T, Onol FF, Ilker Y, Alpay H, SimSek F, Ozek M. The timing of primary neurosurgical repair significantly affects neurogenic bladder prognosis in children with myelomeningocele. J Urol. 2006; 176 (3): 1161-1165.

Oncel MY, Ozdemir R, Kahilogullar? G, Yurttutan S, Erdeve O, Dilmen U. The effect of surgery time on prognosis in newborns with meningomyelocele. J Korean Neurosurg Soc. 2012; 51 (6): 359-362.

Lobo GJ, Nayak M. V-Y plasty or primary repair closure of Myelomeningocele: Our experience. J Pediatr Neurosci. 2018; 13 (4): 398-403.

Singh D, Rath GP, Dash HH, Bithal PK. Anesthetic concerns and perioperative complications in repair of myelomeningocele: a retrospective review of 135 cases. J Neurosurg Anesthesiol. 2010 Jan; 22 (1): 11-5.






Original Articles