CHAPTER 119 Neurodisability Dan

Introduction Neurodisability is probably the most significant contributor to chronic surgical disability in African children. It involves primarily hydrocephalus (HC) and spina bifida (SB), which can occur in isolation or together. Other causes of neurodisability include encephaloceles, which are part of the spectrum of neural tube defects (NTDs). True cerebral palsy is primarily nonsurgical, and therefore not included in this chapter. Hydrocephalus is the excessive accumulation of cerebrospinal fluid (CSF) within the cranial vault. Its management in developing nations is hindered by significant economic constraints and delays in treatment— most patients, in fact, do not present for several months after the onset of clinical symptoms. The management of hydrocephalus and the complications associated with its treatment require considerable surgical judgment and a lifelong approach to patient follow-up. Spina bifida is the term used for a spectrum of congenital NTDs. Other terms used for these anomalies are spinal dysraphisms or myelodysplasias. NTDs are complex medical problems that challenge surgeons and paediatricians alike, both in their initial management and in their lifelong complications. Even though SB may become a vanishing disease in developed countries, it remains a very significant cause of morbidity and disability in the developing world.