Tips and Techniques for Closing Myelomeningoceles in Children

  • Await skin resection until time of its closure: At the beginning of the procedure it is preferable not to excise skin that may be needed later for the closure. It is safer to excise the excess skin after the superficial fascia has been approximated. Remember that the dysplastic epithelial tissue is better than a skin graft.
  • Avoid leaving dermal elements on placode: Careful dissection of the epidermis and dermal structures from the neural placode prevents secondary complications of enlarging dermal inclusion cysts and dermal sinus tracts. This includes the thin transparent ectodermal layer covering the sac.
  • Use simple closure: The majority of lesions can be simply closed without extensive mobilization of the deep lumbar dorsal fascia with or without muscle attachments.