Selection for treatment in spina bifida cystica

This paper discusses (1) the mortality in 295 patients with myelomeningocele born 1961-9, (2) the "quality of life" of 88 surviving patients born 1961-5, and (3) their implications for selection for treatment in spina bifida cystica. Evidence is presented that high neurological levels, the presence of severe hydrocephalus, especially if present at birth, meningitis and ventriculitis, and gross renal disease are very adverse factors both in mortality and in quality of life. In selection for treatment we recommend immediate repair of the sac in most low lesions, deferring treatment in high lesions, and re-evaluation of the survivors of the latter group at 1 month or later.