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What Is Myelomeningocele Repair?

Myelomeningocele repair is surgery that closes an open spinal defect caused by the most severe common form of spina bifida. In myelomeningocele, the spinal cord or nerve tissue and meninges protrude through an opening in the vertebral column and are exposed or covered by a fragile sac. Repair can be performed soon after birth or, in carefully selected pregnancies, before birth with fetal surgery. The operation protects exposed neural tissue and closes the defect but cannot reverse nerve damage that developed before repair.

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What Is Myelomeningocele Repair?

Myelomeningocele repair is surgery that closes an open spinal defect caused by the most severe common form of spina bifida. In myelomeningocele, the spinal cord or nerve tissue and meninges protrude through an opening in the vertebral column and are exposed or covered by a fragile sac. Repair can be performed soon after birth or, in carefully selected pregnancies, before birth with fetal surgery. The operation protects exposed neural tissue and closes the defect but cannot reverse nerve damage that developed before repair.

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Why Is Myelomeningocele Repair Performed?

Postnatal repair is performed to protect the spinal cord from trauma and infection and to create a durable skin and tissue closure. Prenatal repair can be considered for selected fetuses because the Management of Myelomeningocele Study (MOMS) randomized trial found lower need for cerebrospinal-fluid shunting and better motor outcomes in some children compared with standard postnatal closure. Fetal surgery also carries maternal and pregnancy risks, including uterine complications and increased likelihood of preterm delivery. Eligibility therefore depends on gestational age, lesion level, fetal anatomy, maternal health, prior uterine surgery, and evaluation at an experienced fetal-treatment center.

How Is Myelomeningocele Repair Performed?

During postnatal repair, the neurosurgeon carefully separates and protects the exposed neural placode, closes the surrounding dura, and reconstructs muscle, fascia, and skin over the spinal defect. Large defects can require plastic-surgical flaps for tension-free coverage. Prenatal repair follows the same goal but is performed while the fetus remains in the uterus through an open maternal operation or, at selected centers, a fetoscopic approach. After fetal closure, the pregnancy continues under close maternal-fetal monitoring until delivery.

What Is Recovery Like After Myelomeningocele Repair?

Newborns are monitored for wound healing, cerebrospinal-fluid leakage, infection, hydrocephalus, bladder and bowel function, and lower-extremity neurologic status. Some infants still require a shunt or endoscopic treatment for hydrocephalus after repair. Long-term care commonly involves neurosurgery, urology, orthopedics, rehabilitation, physical therapy, and developmental services because myelomeningocele affects multiple organ systems. Children also require ongoing surveillance for tethered cord, scoliosis, orthopedic deformities, skin injury, and changes in bladder or kidney function.

What Are the Risks and Complications?

Postnatal surgical risks include infection, wound breakdown, cerebrospinal-fluid leakage, bleeding, and injury to exposed neural tissue. Later complications can include tethered spinal cord, progressive weakness, orthopedic deformity, hydrocephalus, or repeated neurosurgical procedures. Prenatal repair adds maternal risks such as bleeding, infection, uterine scar problems, and complications in future pregnancies. It also increases the risk of preterm labor, premature membrane rupture, and preterm birth.

Frequently Asked Questions About Myelomeningocele Repair

Can myelomeningocele be repaired before birth?

Yes. Prenatal repair is available for carefully selected pregnancies at specialized fetal-surgery centers after detailed maternal and fetal evaluation.

Does prenatal repair cure spina bifida?

No. It can improve selected outcomes and reduce some complications, but it does not restore neural tissue that was already damaged and does not eliminate lifelong follow-up needs.

When is postnatal myelomeningocele repair performed?

Closure is generally performed soon after birth once the newborn is stabilized, with the exposed lesion protected from contamination and trauma until surgery.

Can a child still need a shunt after myelomeningocele repair?

Yes. Hydrocephalus can persist or develop after either prenatal or postnatal repair, and some children still require cerebrospinal-fluid diversion.

References

Myelomeningocele. StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK546696/. Date Accessed September 11, 2026.

A randomized trial of prenatal versus postnatal repair of myelomeningocele. PubMed. https://pubmed.ncbi.nlm.nih.gov/21306277/. Date Accessed September 11, 2026.

Prenatal Versus Postnatal Surgical Management for Myelomeningocele: A Systematic Review and Comparative Meta-Analysis. PubMed. https://pubmed.ncbi.nlm.nih.gov/41636521/. Date Accessed September 11, 2026.

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Incidence of Shunt-Dependent Hydrocephalus in Infants With Myelomeningocele After Prenatal Versus Postnatal Repair. PubMed. https://pubmed.ncbi.nlm.nih.gov/31418039/. Date Accessed September 11, 2026.

Myelomeningocele closure: A review and decision-making guidance. PubMed. https://pubmed.ncbi.nlm.nih.gov/41280468/. Date Accessed September 11, 2026.