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Unfortunately, few long\u2010term outcome studies are available to help direct the neurosurgical care of a child born with myelomeningocele and often treatment relies more heavily upon the experience of senior practitioners. This article reviews the current literature regarding neurosurgical treatment strategies, with recommendations concerning including prenatal diagnosis, in utero treatment and delivery modes, and postnatal management. Given the overall declining prevalence of open neural tube defects world\u2010wide, research collaboration amongst practitioners through multicenter trial are essential to improving the lives of people born with this most complex congenital anomaly. \u00a9 2010 Wiley\u2010Liss, Inc. 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