title: [How I do it: myelomeningocele in bolivia].
abstract: Neural Tube Defects (NTD) are the second congenital malformation, second only to cardiac malformations. Myelomeningocele (MMCL) is the most frequent NTD and the more complex. In Bolivia, like in many countries in South America, the low socio economical level of the population increases its incidences and complicates its management.
  
  
  
  Retrospective study of 70 cases of MMC at Hospital Universitario Japonés (HUJ), Santa Cruz de la Sierra, between 2008-2011. Sixty had surgery.
  
  
  
  Prenatal care in 27 women (38.6%), positive diagnosis for spinal disraphism in 2 (7.4%). The child arrived after 24 hours of birth (65.5%). Lumbosacral lesion (64.3%). Of those 67.2% were open, with 32.9% evidencing partial motor lesion in contrast with 47.1% who were paraplegic bellow the level of the lesion. Three children were not operated because they had complex and severe malformations associated to the MMCL. The most common surgical complications were; wound dehiscence or infection (16.6%), CSF fistula (10%) CNS infection (11.7%). Mortality and specifically postoperative mortality were 7.1% y 3.3%, respectively. Hydrocephalus wass evident in 80% of the patients who were operated, they received a VP shunt medium pressure. Nine patients who had long term follow up presented with tethered cord.
  
  
  
  A characteristic, delayed referral. No gender predominance. Majority of cases were lumbar or lumbar sacral. Mortality similar to what is reported in the literature. Few patients came for follow up. MMCL is a pathology that requires concentrated attention by the national authorities. A multi center and multi national study will improve our management of these patients.
authors.affiliation: Neurosurgical Division, Japanese University Hospital, Santa Cruz de la Sierra, Bolivia.
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Dabdoub
authors.affiliation: Neurosurgical Division, Japanese University Hospital, Santa Cruz de la Sierra, Bolivia.
authors.forename: Carlos B
authors.initials: CB
authors.lastname: Dabdoub
authors.affiliation: Hospital Caja Petrolera de Salud, Santa Cruz de la Sierra, Bolivia.
authors.forename: Ramiro
authors.initials: R
authors.lastname: Villavicencio
authors.affiliation: Pediatric Urological Division. Japanese University Hospital. Santa Cruz de la Sierra, Bolivia.
authors.forename: Germán
authors.initials: G
authors.lastname: Quevedo