1. Hatem I. Badr MD. ASS. Professor Neurosurgery Department of Neurosurgery Mansoura University, Egypt CNS congenital anomalies

6. Dimple

7. Tuft of hair

8. Dimple with nauves port wine

10. Autopsy of Infant with tethered cord

13. Myelomeningocele

14. Intact Mylomeningocele Thin transparent membrane

15. Intact Mylomeningocele covered by thin membrane surrounded by hyper pigmentation

16. Financial Costs : Average estimated lifetime cost of $532,000 for each infant born with spina bifida (CDC 1999) adds an estimated 19 million dollars every year to Missouri resident lifetime costs associated with spina bifida. Physical Costs : Possible paralysis (the leading cause of childhood paralysis), bowel and bladder control problems, learning disabilities, hydrocephalus, surgical procedures, latex allergies, increased health problems with age Emotional Costs : Miscarriage, stillbirth, infant mortality (death before 1st birthday), disability, feeling “different” The High Cost of NTDs

17. How do you get diagnosis?

21. Is prophylaxis feasible?

25. What is the proper management?

30. Intra-operative Cauda equina Dural edge placode

31. Post-operative

32. FOR THE FUTURE

33. Baby Samuel Armas's tiny fingers grasped the doctor's huge hand - - not at birth but, at 21 weeks during surgery for repair of MM Samuel Armas Photo 8/19/99; Born 12/2/99

34. Sara Switzer Photo: July 1 st /99; Born August 22 nd /99 BORN TWICE

35. Hydrocephalus

36. Thank You