الفهرس 
Acknowledgement
Anterior sacral meningoceleOnly 14 pages are availabe for public view
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Abstract
Neural development is one of the earliest systems to begin and the last to be completed after birth.
Neural tube defects (NTD) occur because of a defect in the neurulation process. Since the anterior and posterior neuropores close last, they are the most vulnerable to defects. Consequently, a majority of NTDs arise.
Indian and Eastern Mediterranean populations (with the exception of Israeli Jews) have relatively high incidences of NTDs. However, unlike the Western white populations, anencephaly is more common than spina bifida in these areas.
Cranial presentations include the following:
• Anencephaly
• Encephalocele (meningocele or meningomyelocele)
• Craniorachischisistotalis
• Congenital dermal sinus
Spinal presentations include the following:
• Spina bifida aperta (cystica)
• Myelomeningocele.
The etiology in most cases of myelomeningocele is multifactorial, involving genetic, racial, environmental factors and nutrition particularly folic acid intake, is key. Cytoplasmic factors, polygenic inheritance, chromosomal aberrations, and environmental influences (eg, teratogens) have all been considered as possible causes. Periconceptional folate supplementation has a strong protective effect against NTDs.
Screening for Neural tube defects is initiated in the early part of second trimester with determination of Maternalserum alpha feto-protein (MSFP). Prenatal US and MRI is highly diagnostic of NTDs as a non-invasive method along with invasive prenatal diagnostic methods as Amniocentesis.
Recently, In utero surgical fetal surgery for myelomeningocele repair has been introduced in some institutions and has been shown to result in improved neurological function and decreased morbidity. Other methods for closure of the defect include:
• Primary skin closure
• Musculocutaneous flap(Limberg Flap)
• Fasciocutaneous flap
• Skin graft
Our study aims to get an experience on closure of the back defect post-meningocele and myelomeningocele repair and to put an algorithm for management of such cases.
According to the defect size after the repair of the dura, we classified the patients into 3 groups:
The first group(1x2cm to 4x 4 cm) that was closed directly .The second group(4x4 to 7x7 cm) that was closed by local skin fasciocutaneous flap
• Third group that was closed by skin graft (split-thickness skin graft due to large defect more than 7×7cm with immobile enough skin for skin flap.
In present study in the group of direct repair five cases had complications. One case was gapped wound treated by rotational flap, second case with mild leak resolved sponataneously, third case with CSF leak not stopped conservatively treated by insertion of right VP shunt, fourth case developed pseudomeningocele was treated by insertion of right VP shunt, and the last case developed respiratory distress postoperatively not related to the surgical procedure was transferred to the neonatal ICU and improved, also in rotational falp there were five cases who had ischemic edges not with the flap itself that healed by daily dressing by betadine ointment.