Surgical considerations in the management of myelomeningocele

A brief summary is presented of the epidemiological, embryological, clinical, and etiological aspects of myelomeningocele. The natural history of this disease is reviewed, as are the implications of present-day treatment. An analysis is made of the cost of overall treatment, including neurological, orthopedic and urological surgery, as well as physical and psychological rehabilitation and specialized educational therapy. The costs are high, both monetarily and from the viewpoint of social handicaps. The author's personal experience is analyzed. The outcome of treatment is poor, probably due to the economic limits which do not allow full treatment. Several questions are asked: Should these children be operated upon? Which children should be operated upon? Who must bear the costs of treatment? The author gives his point of view concerning these questions.