Child's Nervous System

, Volume 35, Issue 11, pp 2205–2210 | Cite as

Intracranial infection in patients with myelomeningocele: profile and risk factors

  • Ambrose O. Anegbe
  • M. Temitayo ShokunbiEmail author
  • Toyin A Oyemolade
  • Oluwakemi A. Badejo
Original Article



To describe the profile and determine the risk factors for the development of intracranial infections (ICI) in paediatric patients with myelomeningocele (MMC).


Retrospective analysis of data from the records of patients with MMC admitted into our hospital between January 2006 and December 2015.


We managed a total of 688 paediatric non-trauma neurosurgical patients in our facility during the study period. 29.4% of these patients had MMC. We found the records for 49% of the patients. The male: female ratio was 1.3:1. Most of the MMCs were located in the lumbosacral region (71.7%). The lesion was ruptured in 42.4%, unruptured in 53.5%, and indeterminate in 4.0% of the patients. 48.5% of the MMCs were infected at presentation. Surgical repair of the spinal dysraphism was performed in 74.7% of the patients. Postoperative complications observed in our series include wound dehiscence, cerebrospinal fluid leak, and pseudomeningocele which occurred in 13.5%, 12.2%, and 2.7% of the operated cases of MMC respectively. 28.3% of the patients with MMC developed ICI during the course of hospitalization. 71.4% of patients with MMC-associated ICI had septic neural placode at the initial clinical evaluation. 70% of the patients who had wound dehiscence post-operatively developed ICI. Loculations and abscesses occurred only in patients who had surgical repair. A multivariate logistic regression analysis revealed that septic neural placode, hydrocephalus, a supra-lumbar location of the MMCs and surgical intervention were predictive of ICI (p < 0.05).


Infection of the neural placode, hydrocephalus, locations of the lesions above the lumbar region, and surgical repair were the statistically significant risk factors for ICI in our study population. The trending but statistically insignificant risk factors for ICI in our series may require further assessment with a larger sample size.


Spina bifida cystica Meningitis Ventriculitis Spinal dysraphism 


Compliance with ethical standards

Conflict of interest

The author declares that they have no conflict of interest.


  1. 1.
    Abubakr DS, Mohammed AE, Alla AM (2014) Spina bifida in Sudan. J Neurol Neurosci 5:1–8. CrossRefGoogle Scholar
  2. 2.
    Najat F, Baradaran N, El Khahab M (2011) Large myelomeningocele repair. Indian J Plast Surg 44:87–90CrossRefGoogle Scholar
  3. 3.
    Kaplan M, Ulcer N, Bayrakli F, Duz B, Erol FS (2010) Diagnosis of central nervous system infection by CSF sampling of the myelomeningocele sac as an alternative to ventricular tap. Neurocirugia (Astur) 21:228–231CrossRefGoogle Scholar
  4. 4.
    Caldarelli M, Di Rocco C, La Marca F (1996) Shunt complications in the first postoperative year in children with meningomyelocele. Childs Nerv Syst 12:748–754CrossRefGoogle Scholar
  5. 5.
    Gamache FW (1995) Treatment of hydrocephalus in patients with meningomyelocele or encephalocele: a recent series. Childs Nerv Syst 11:487–488CrossRefGoogle Scholar
  6. 6.
    McLone DG, Dias MS (1991) Complications of myelomeningocele closure. Pediatr Neurosurg 17:267–273CrossRefGoogle Scholar
  7. 7.
    Rennie JM (1999) Central nervous system malformation. In: Rennie JM, Roberton MRC (eds) Textbook of neurology, 3rd edn. Churchill Livingstone, Edinburgh, pp 1297–1311Google Scholar
  8. 8.
    Asindi A, Al-Shehri A (2001) Neural tube defects in the Asir region of Saudi Arabia. Ann Saudi Med 21:26–29CrossRefGoogle Scholar
  9. 9.
    Carter CO (1974) Clues to the aetiology of neural tube malformations. Dev Med Child Neurol 16:3–15CrossRefGoogle Scholar
  10. 10.
    Food and Drug Administration (1996) Food standards: amendment of standards of identity for enriched grain products to require addition of folic acid. Fed Register 61:8781–8797Google Scholar
  11. 11.
    Adeleye AO, Olowookere KG (2009) Central nervous system congenital anomalies: a prospective neurosurgical observational study from Nigeria. Congenit Anom (Kyoto) 49:258–261CrossRefGoogle Scholar
  12. 12.
    Gedefaw A, Teklu S, Tadesse BT (2018) Magnitude of neural tube defects and associated risk factors at three teaching hospitals in Addis Ababa, Ethiopia. Biomed Res Int. CrossRefGoogle Scholar
  13. 13.
    Benclowe H, Kancherla V, Moorthie S, Darlison M, Modell B (2018) Estimates of global and regional prevalence of neural tube defects for 2015: a systematic analysis. Ann N Y Acad Sci 1414:31–46. CrossRefGoogle Scholar
  14. 14.
    Sever LE, Lowell E, Sanders M, Monsen R (1982) An epidemiologic study of neural tube defects in Los Angeles County I. prevalence at birth based on multiple sources of case ascertainment. Teratology 25:315–321CrossRefGoogle Scholar
  15. 15.
    Liptak GS, Dosa NP (2010) Myelomeningocele. Pediatr Rev 31:443–450. CrossRefPubMedGoogle Scholar
  16. 16.
    Alatise OI, Adeolu AA, Komolafe EO, Adejuyigbe O, Sowande OA (2006) Pattern and factors affecting management outcome of spina bifida cystica in Ile-Ife, Nigeria. Pediatr Neurosurg 42:277–283CrossRefGoogle Scholar
  17. 17.
    Öktem IS, Menku A, Özdemir A (2008) When should ventriculoperitoneal shunt placement be performed in cases with myelomeningocele and hydrocephalus? Turk Neurosurg 18:387–391PubMedGoogle Scholar
  18. 18.
    Uba AF, Isamade ES, Chirdan LB, Edino ST, Ogbe ME, Igun GO (2004) Epidemiology of neural tube defects in north Central Nigeria. Afr J Paediatr Surg 1:16–19Google Scholar
  19. 19.
    Lorber J (1961) Systematic ventriculographic studies in infants born with meningomyelocele and encephalocele. The incidence and development of hydrocephalus. Arch Dis Child 36:381–389CrossRefGoogle Scholar
  20. 20.
    Katikar DB, Jaykar RD, Kamble M, Agrawal S (2014) Study of surgical intervention in patient of Meningocele with hydrocephalus: simultaneous V/S sequential group. Int J Recent Trends Sci Technol 11:17–24Google Scholar
  21. 21.
    Haslam RHA (2000) Congenital anomalies of the central nervous system. In: Behrman RE, Kliegman RM, Jenson HB (eds) Nelson textbook of pediatrics, 16th edn. WB Saunders Co, Philadelphia, pp 1803–1810Google Scholar
  22. 22.
    Hashim SM, Ahmed S, Jooma R (2008) Management of myelomeningocele. J Surgery Pakistan 13:7–11Google Scholar
  23. 23.
    Halaby WE, Ismail MT (2016) Delayed hydrocephalus after repairing un- rupture Myelomeningocele. Egypt J Neurosurg 31:167–170Google Scholar
  24. 24.
    Shehu BB, Ameh EA, Ismail NJ (2000) Spina bifida cystica: selective management in Zaria, Nigeria. Ann Trop Paediatr 20:239–242CrossRefGoogle Scholar
  25. 25.
    Guthkelch AN, Pang D, Vries JK (1981) Influence of closure technique on results in myelomeningocele. Childs Brain 8:350–355PubMedGoogle Scholar
  26. 26.
    Brau RH, Rodríguez R, Ramírez MV, González R, Martínez V (1990) Experience in the management of myelomeningocele in Puerto Rico. J Neurosurg 72:726–731CrossRefGoogle Scholar
  27. 27.
    Charney EB, Melchionni JB, Antonucci DL (1991) Ventriculitis in newborns with myelomeningocele. Am J Dis Child 145:287–290PubMedGoogle Scholar
  28. 28.
    Seidel SB, Gardner PM, Howard PS (1996) Soft-tissue coverage of the neural elements after myelomeningocele repair. Ann Plast Surg 37:310–316CrossRefGoogle Scholar
  29. 29.
    Ammirati M, Raimondi AJ (1987) Cerebrospinal fluid shunt infections in children. A study on the relationship between the etiology of the hydrocephalus, age at the time of shunt placement, and infection rate. Childs Nerv Syst 3:106–109CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ambrose O. Anegbe
    • 1
  • M. Temitayo Shokunbi
    • 1
    Email author
  • Toyin A Oyemolade
    • 1
  • Oluwakemi A. Badejo
    • 1
  1. 1.Division of Neurological Surgery, Department of Surgery, College of MedicineUniversity of IbadanIbadanNigeria

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