Large myelomeningocele closure: a case series from a regional neurosurgical centre in northwestern Nigeria

Abstract

Background: Achieving a tension-free wound closure of large myelomeningocele remains a major concern for all neurosurgeons. Even though this could be achieved by a simple method of undermining the skin surrounding the defect, it can be riddled with technical challenges. As such, surgeons developed various methods to achieve wound closure without tension of large myelomeningocele defects. In this paper, we report our experience in the wound closure of large myelomeningoceles in a regional neurosurgical centre in northwestern Nigeria and review the literature. Methodology: A retrospective study that reviewed all patients with large myelomeningoceles who had surgical intervention at Usmanu Danfodiyo University Teaching Hospital (UDUTH) from January 2021 to December 2023. Data was obtained from the patients' case notes. Results: A total of six patients with large myelomeningocele were operated on during the study period. Five were males with a male-to-female ratio of 5:1. All the patients presented during infancy with a mean age of 3.5 months. Hydrocephalus was the most common associated abnormality. All had excision and simple wound closure after undermining the skin surrounding the defects. Five (83.3%) patients had no complications in the post-operative period. One patient (16.7%) had a pseudomeningocele that was treated by wound exploration and dural repair. Conclusion: By undermining the edges of a large myelomeningocele, tension-free closure is achieved with favourable outcomes.