{"id":"8c98a223-0cd5-4c78-bdcc-886826e01292","slug":"como-lo-hago-yo-anomalias-del-tubo-neural-en-guatemala-mielomeningocele-unidad-de-espina-bifida-e-hidrocefalia","title":"Como Lo Hago Yo: Anomalías del Tubo Neural en Guatemala — Mielomeningocele Unidad de Espina Bífida e Hidrocefalia","authors":["Graciela Manucci","Enzo von Quednow"],"abstract":"En Guatemala nacen por añ 786 niños con defectos de tubo neural. Operamos 65 a 70 niños con mielomenigocele por año. Tenemos equipo multidisciplinario. Recomendamos parto por cesárea. Infección antes de la cirugía es un problema mayor. Derivación tardía es un problema. Disecamos la plaqueta con la técnica clásica. Suturamos la plaqueta para restituir la forma de la médula. Corpectomía en casos de cifósis. Hidrocefalía: Operamos el 80% de los niños. Chiari II: Operamos basados en los síntomas, primero nos aseguramos que la válvula funciona bien. Médula anclada: Operamos basados en los síntomas. In Guatemala the prevalence of Neural Tube Defects (NTD) is approximately of 2.34 per 1,000 live births. It represents the most frequent congenital anomaly. Surpassing cleft palate and abdominal wall malformation. Considering that the country has an annual population growth rate of 2.8% we can infer that of 336,000 new born per year, 786 will have a NTD. The higher prevalence is in the NW region, perhaps related to the indigenous population and poor nutritional status. Folic acid deficiency, mycotoxins such as fumonisin or genetic alteration of the metabolism of tetra hidro pholate reductase, key enzyme for folic acid metabolism, could be relevant. Spina Bifida Aperta (myelomeningocele) and Spina Bifida “closed” Encephaloceles, anterior and posterior. The most frequent is the myelomeningocele. While folic acid deficiency is the most common etiological factor it is believed that the high incidence that we have in Guatemala could be secondary to a genetic cause. We have seen many cases in the same family including a 30% of familiar cases where the individuals do not leave in the same region. Since I arrived from my country Argentina to work in Guatemala I devoted my efforts to build a ward at the San Juan de Dios Hospital devoted to the care of NTD and Hydrocephalus and associated conditions. It is the only specialized ward in Central America. In the unit we perform more than 250 surgeries every year, of which 65 to 70 are closing of myelomeningocele. In Guatemala the barriers to care of children with NTD are social, economical and cultural. It is believed by the community and by health care workers that the children with NTD are crippled mentally retarded. Is the most frequent and severe form of spina bifida. It is a complex anomaly that affects the central nervous system but also the renal and urinary system as well as the spinal column and the lower limbs. It has a central portion, the placode, which is pink or red, surrounded by a thin and transparent arachnoid and at the external margin by a transitional tissue, a very thin epidermis that is poorly vascularized and often inadequate for stitching. In our country only 40% of pregnant women have access to prenatal ultrasound.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/8c98a223-0cd5-4c78-bdcc-886826e01292/featured/hero-1782421006803.png","publishDate":"2014-03-10T00:00:00.000Z","doi":"10.4103/2152-7806.128463","categories":["Pediatric Neurosurgery","Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2015/05/4083/SNI-5-13.pdf"}