Spina bifida myelomeningocele is typically treated with surgical closure within the first 48 hours to reduce infection risk and protect the spinal cord. Which statement is true about this early management?

• A. It is performed within 48 hours to reduce infection risk and protect the spinal cord.
• B. It is always avoided and delayed until after birth.
• C. It is unnecessary if hydrocephalus is not present.
• D. It is accomplished only after shunt placement.

Answer: (A)

Early surgical closure of a myelomeningocele is done to protect the exposed spinal cord and neural tissues and to reduce infection risk. When the sac remains open after birth, bacteria can contaminate the neural tissue, leading to meningitis, sepsis, and further neurological damage. Closing the defect within the first 48 hours minimizes these risks by sealing off the exposed tissue and preventing ongoing trauma from environmental exposure. This timing is pursued even if hydrocephalus isn’t present, because the primary goal is to protect the spinal cord and reduce infection risk. Shunt placement for hydrocephalus, if needed, is managed separately and does not have to precede the closure. Delaying closure contradicts the main objective of preventing infection and tissue injury, and closure is not dependent on hydrocephalus status or on prior shunt placement.