Neural Tube Defects and Dysraphism — WACS Viva & Clinical Scenarios (Paediatric Neurosurgery and Congenital Anomalies)

Exam-style neural tube defects and dysraphism viva scenarios with examiner probes and model answers for Neurosurgery candidates.

Scenarios covered

• SCENARIO 1: A newborn infant delivered at a peripheral district hospital is transferred at 12 hours of life with a ruptured thoracolumbar myelomeningocele leaking cerebrospinal fluid. Detail the immediate neonatal stabilization, measures to minimize thermal loss and infection, optimal timing for operative repair, stepwise micro-neurosurgical reconstruction of the placode and soft-tissue coverage, and post-closure surveillance for progressive ventriculomegaly.
• SCENARIO 2: A 4-year-old child presents with progressive gait abnormality, asymmetric calf wasting, cavovarus foot deformity, and newly developed daytime urinary incontinence. Physical examination reveals a lumbosacral hairy patch and a deep coccygeal dimple. Discuss the embryological origins of occult spinal dysraphism, diagnostic neuro-axis MRI findings, anatomical distinction between Type I and Type II split cord malformation, indications for surgical untethering, and intraoperative neurophysiological monitoring protocols.
• SCENARIO 3: A 6-week-old infant who underwent uneventful myelomeningocele repair on day 2 of life presents with inspiratory stridor, weak cry, intermittent apneic spells, and poor feeding. Outline the pathophysiological relationship between spinal dysraphism, Chiari II malformation, and hydrocephalus. Formulate an emergency diagnostic and therapeutic pathway to differentiate acute hindbrain brainstem compression from raised intracranial pressure, detailing the surgical management sequence.
• SCENARIO 4: A 6-month-old infant is brought to the outpatient clinic with a pulsatile, non-tender midline mass at the root of the nose associated with hypertelorism. Provide the anatomical and clinical classification of frontoethmoidal encephaloceles, outline the preoperative radiological evaluation required to identify intracranial communication and vascular anatomy, and detail the stages of a definitive multidisciplinary transbasal craniofacial repair.
• SCENARIO 5: Discuss the neuropathology and urodynamic patterns of lower urinary tract dysfunction associated with congenital myelodysplasia. Describe the protocols for initial urological assessment, principles of clean intermittent catheterization, pharmacological preservation of renal parenchyma against reflux nephropathy, and long-term orthopaedic surveillance for secondary neuromuscular deformities.