Surgical treatment and outcomes of neural tube defects at the university of Gondar Comprehensive Specialized Hospital, Ethiopia: a two-year retrospective review.

introductionSpina bifida, particularly myelomeningocele (MMC), is one of the most common congenital central nervous system abnormalities compatible with life. Despite global efforts to reduce its incidence through folic acid fortification, the burden remains high in low-resource settings like Ethiopia. This study aimed to analyze the pattern of presentation, clinical characteristics, management, and outcomes of spina bifida spectrum disorders (SBSDs) at the University of Gondar Comprehensive Specialized Hospital.

methodsA retrospective cross-sectional study was conducted on 240 neonates and infants with neural tube defects, of whom 176 had confirmed spina bifida spectrum disorders (SBSDs) treated between December 2022 and November 2024 G.C at the University of Gondar Comprehensive Specialized Hospital. Data were extracted from medical records, including demographics, lesion characteristics, associated anomalies, surgical interventions, complications, and discharge outcomes. Descriptive statistics were used for analysis via SPSS version 27.

resultAmong the 176 confirmed SBSD cases (out of the total 240 patients), myelomeningocele was the most prevalent diagnosis, accounting for 77.8% of cases, followed by encephalocele (10.7%) and meningocele (7.9%). The most common lesion locations were lumbosacral (39.4%), lumbar (28.1%), and thoracolumbar (19.4%). Hydrocephalus was present in 78.3% of the total cohort and 71% of SBSD cases, with (66.4%) of those directly associated with SBSD, while sonographic Chiari malformation was identified in (31.3%). Prenatal diagnosis was made only in 10 (4.2%) patients and no counselling or intervention was employed. A total of 260 surgeries were performed for the cases, with the most common being neural tube defect repair/closure (58.5%), and followed by ventriculoperitoneal (VP) shunt insertion (25.0%). Endoscopic third ventriculostomy was done for (5.4%) of cases. Postoperative complications occurred in a considerable proportion of patients (33.8%), although most were minor and manageable, including wound infections (4.2%), seizures (5.0%), shunt malfunctions (0.4%), and mortality rate was (4.6%). Only 109 patients (45.4%) received physical rehabilitation, and developmental delays were noted in 107 (44.6%) cases. School attendance data were undocumented in (78.8%) of patients.

conclusionThe study highlights the higher prevalence of severe SBSDs in northwest Ethiopia, with significant associated morbidity. While surgical management addressed immediate needs, comprehensive care remained deficient. Major gaps persist in prenatal prevention, multidisciplinary follow-up, and rehabilitation. Enhancing public health strategies-including folic acid supplementation, early diagnosis, and integrated care-is essential to improve the overall outcomes.