Operative Planning

• Appropriate counseling and parent/family teaching
  
  
  
  • Discuss neurologic prognosis
    
  • Discuss hydrocephalus, Chiari II malformation, and other comorbidities
  
  
• In utero ultrasound/magnetic resonance imaging helpful but not mandatory
  
• Delivery by caesarian section
  
• Nursing education
  
  
  
  • Cover defect with sterile gauze
    
  • Maintain latex precautions
    
  • Keep infant prone
  
  
• Repair within 24 to 72 hours
  
• Neurologic assessment
  
• Systemic assessment for other congenital anomalies
  
  
  
  • Cranial, renal ultrasound
    
  • Echocardiogram
    
  • Chest/spinal x-rays
  
  
• Pediatric, orthopedic, and urologic consultations when early comorbidities present

Special Equipment

• Spinal tray
  
• Plastics tray
  
• Jeweler’s bipolar

Anesthetic Issues

• Latex allergy precautions
  
• Intubate patient supine with neural placode protected from compression using foam donut
  
• Intravenous antibiotics, Foley catheter, heat lamps