Influence of closure technique on results in myelomeningocele

The results of the repair of myelomeningoceles by, respectively, reconstitution of the neural tube and simple replacement of the placode within the dural sheath are examined. It is concluded that neither offers any significant advantages over the other. When no neurologic function is present below the upper level of the lesion, no method of repair is likely to result in improvement, while the mere preservation of reflex activity in the distal segment of cord may be counterproductive. It is suggested, therefore, that there is a place for immediate excision of the lesion in properly selected cases.