title: Myelomeningocele Repair: Surgical Management Based on a 30-Year Experience.
abstract: Myelomeningocele (MMC) is a rare but severe spinal defect resulting from a failed neurulation process. Surgical repair is a delicate procedure that needs accurate neuroanatomical knowledge and adequate surgical planning.
  
  
  
  The authors report on the main problems of the surgical management of this type of dysraphism. The technique used for reconstruction, and the management strategies, are analyzed according to the authors' experience with more than 600 cases, in comparison with the relevant literature.
  
  
  
  Tip and tricks of more than 30 years of MMC surgical management are reported, with special mention of the timing of surgery, the management of early hydrocephalus, and the principles of the repair, from the dissection to the closure of five separate layers (arachnoid, dura, muscular fascia, subcutaneous layer, skin).
  
  
  
  Accuracy and attention to the reconstruction are crucial for achieving good results and avoiding perioperative complications.
authors.affiliation: Pediatric Neurosurgery - A. Gemelli Hospital, Catholic University Medical School, Largo A. Gemelli, Rome, Italy. pierpaolo.mattogno@gmail.com.
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Mattogno
authors.affiliation: Pediatric Neurosurgery - A. Gemelli Hospital, Catholic University Medical School, Largo A. Gemelli, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Massimi
authors.affiliation: Pediatric Neurosurgery - A. Gemelli Hospital, Catholic University Medical School, Largo A. Gemelli, Rome, Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Tamburrini
authors.affiliation: Pediatric Neurosurgery - A. Gemelli Hospital, Catholic University Medical School, Largo A. Gemelli, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Frassanito
authors.affiliation: Pediatric Neurosurgery - A. Gemelli Hospital, Catholic University Medical School, Largo A. Gemelli, Rome, Italy.
authors.forename: Concezio
authors.initials: C
authors.lastname: Di Rocco
authors.affiliation: Pediatric Neurosurgery - A. Gemelli Hospital, Catholic University Medical School, Largo A. Gemelli, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Caldarelli
mesh_terms: D005260:Female; D046128:Fetal Therapies / Q000379:methods*; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D007231:Infant, Newborn; D008591:Meningomyelocele / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019635:Neurosurgical Procedures; D011247:Pregnancy; D019651:Plastic Surgery Procedures; D013997:Time Factors; D016216:Ultrasonography, Prenatal; D017287:Ventriculoperitoneal Shunt
keywords: Hydrocephalus; Myelomeningocele; Spina bifida; Surgical repair