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Spina bifida occurs frequently in our environment. Low socio-economic status and poor antenatal clinic visits contributes significantly to its occurrence.

Background:It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region.Objective:To review the pattern and practice of paediatric neurosurgical day-cases at our hospital.Patients and Methods:A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014.Results:A total of 53 patients (34 males and 19 females) with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4%) presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32%) followed by ventriculoperitoneal shunt insertion (26.4%) for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32%) belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality.Conclusion:Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved.

Regarding this survey of 254 patients, the authors state that the overall prevalence of family history of neural tube defects (NTDs) in children with an NTD was 16.9%, of which 3.1% occurred in firstdegree relatives. The findings reported by these authors also interestingly reveal that in patients with myelomeningocele, as many as 17.7% had a positive family history for NTDs, with up to 3.8% of cases occurring in first-degree relatives. These figures appear to be remarkably much higher than the rates previously documented for positive family history in patients with NTDs, as shown in Table 5 of the article by Dupépé et al. 4 However, we observed that the cited literature on previously documented findings shown in Table 5 of the authors' discussion includes no established statistics from an African setting. Therefore, we present a few available statistics on this etiological aspect of NTDs in Table 1 of this letter. 1,3,6 Of particular interest to note is the same marked contrast of our local observations in Africa with the previously published statistics presented by Dupépé et al. The established prevalence of family history of NTDs at our center in Nigeria is in fact 0.9% 1 (Table 1), though we have not noticed any significant change in positive family history from unpublished data of our more recent research. Furthermore, we also observed that the most recent among all the cited literature in Table 5 of the discussion by Dupépé et al. was published in 1995 (Partington and McLone). So, as Dupépé et al. rightly mentioned, virtually INCLUDE WHEN CITING