title: Surgical treatment of myelomeningocele carried out at 'time zero' immediately after birth.
abstract: OBJECTIVE
  To present a protocol of immediate surgical repair of myelomeningocele (MMC) after birth ('time zero') and compare this surgical outcome with the surgery performed after the newborn's admission to the nursery before the operation.
  
  
  METHODS
  Data from the medical files of 31 patients with MMC that underwent surgery after birth and after admission at the nursery (group I) were compared with a group of 23 patients with MMC admitted and prospectively followed, who underwent surgery immediately after birth--'at time zero' (group II).
  
  
  RESULTS
  The preoperative rupture of the MMC occurred more frequently in group I (67 vs. 39%, p < 0.05). The need for ventriculoperitoneal shunt was 84% in group I and 65% in group II and 4 of them were performed during the same anesthetic time as the immediate MMC repair, with no statistically significant difference. Group I had a higher incidence of small dehiscences when compared to group II (29 vs. 13%, p < 0.05); however, there was no statistically significant difference regarding infections. After 1 year of follow-up, 61% of group I showed neurodevelopmental delay, whereas only 35% of group II showed it.
  
  
  CONCLUSIONS
  The surgical intervention carried out immediately after the birth showed benefits regarding a lower incidence of preoperative rupture of the MMC, postoperative dehiscences and lower incidence of neurodevelopmental delay 1 year after birth.
authors.affiliation: Division of Neurosurgery, Hospital das Clinicas, Av. Angélica 1968, São Paulo, SP, Brazil. fernando.neuro@terra.com.br
authors.forename: Fernando Campos Gomes
authors.initials: FC
authors.lastname: Pinto
authors.forename: Hamilton
authors.initials: H
authors.lastname: Matushita
authors.forename: André Luiz Beer
authors.initials: AL
authors.lastname: Furlan
authors.forename: Eduardo Joaquim
authors.initials: EJ
authors.lastname: Alho
authors.forename: Dov Charles
authors.initials: DC
authors.lastname: Goldenberg
authors.forename: Victor
authors.initials: V
authors.lastname: Bunduki
authors.forename: Vera Lúcia Jornada
authors.initials: VL
authors.lastname: Krebs
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008591:Meningomyelocele / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D011300:Preoperative Care / Q000379:methods / Q000639:trends; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult