The repair of large complex myelomeningoceles remains one of the most difficult challenges facing pediatric neurosurgeons. Recent collaboration with our plastic surgery colleagues has led to the joint introduction of repair techniques for these complex malformations. Our current practice is for the neurosurgical team to expose the neural elements and placode of the myelomeningocele and release them from the surrounding tissues. Once the neural reconstruction is completed the plastic surgery team completes the reconstruction with appropriate flaps and skin rotations. Our center has been using these techniques for over two decades with very gratifying results. The surgical exposures and nuances of these complex closures are discussed below.
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