Neuroimaging patterns of structural brain anomalies and associated factors in children with Spina bifida attending at Muhimbili Orthopaedic Institute and Muhimbili National Hospital, Dar-es-salaam, Tanzania.

Abstract

ABSTRACT Background: Spina bifida (SB) is a neural tube defect that occurs as a result of incomplete closure of the neural tube during the fourth week of embryonic development. It is the most common and most complex non-fatal neurological birth defect. This can result in a range of physical and neurological impairments. Despite its prevalence and impact, there is little data on SB neuroimaging pattern and associated factors. Objective: The main aim of this study was to explore spina bifida patterns, brain anomalies and associated factors. Methodology: From June 2022 to February 2024, an extensive cross-sectional study was conducted at Muhimbili Orthopaedic Institute and Muhimbili National Hospital-Upanga. Maternal-child clinical data, intra-operative Endoscopic Third Ventriculostomy (ETV), and brain and spine MRI data of 90 children with spina bifida were collected and analysed using SPSS version 26. The analysis employed descriptive statistics, binary, and multinomial logistic regression, with a significance level set at p-value < 0.05. Results: 60% of the study participants were males. The majority of the study participants (75.6%) were neonates, with median age of 9.5 days and interquartile range of 4.5 days. 27.8% (25/90) were born with a low birth weight (BW < 2500g). A total of 17 (18.9%) study participants are the fourth or older child in their family. All children had SB aperta, with most having myelomeningocele (86.7%). Chiari malformation (93.3%) and hydrocephalus (88.9%) were the most prevalent brain anomalies. Children with upper SB lesion level and larger defect span had higher occurrence of abnormal corpus-callosum, cavum-septum-pellucidum and cerebellum (p-value< 0.05). Male sex (OR 5.8; 95%CI 1.0 – 33.1; p-value 0.049) and maternal anaemia (OR 24.0; 95%CI 4.5 – 128.3; p-value < 0.001) were associated with higher odds for having an upper SB lesion level and larger defect span. The presence of intraventricular septations on MRI correlated well with turbid CSF on ETV (p-value 0.045). Conclusion: There was significant diversity in associated brain anomalies among spina bifida patterns. Higher occurrence of anomalies is noted with upper SB lesion level and larger defect span. Maternal anaemia and male sex are independent risk factors for severe spina bifida. Brain MRI may help to predict intra-operative ETV findings. Recommendations: Findings from this study highlight the importance of detailed CNS evaluation in children with spina bifida. The association of severe forms of spina bifida with maternal anaemia underscores the importance of pre-conceptual folic acid in the prevention of neural tube defect in Tanzania. Further studies on the cognitive and functional outcome of children with spina bifida are recommended.