Impact of surgical timing and concomitant anomalies on neonatal meningomyelocele outcomes: a single-center experience.

To present a decade-long single-center experience with neonatal meningomyelocele (MMC) and to emphasize the impact of surgical timing and concomitant anomalies in these neonates. Neonates with MMC between 2012 and 2022 were retrospectively analyzed. Perinatal data, concomitant deformities and anomalies, maternal data, MMC repair surgery duration, concurrent surgeries, complications, and central nervous system (CNS) infection were evaluated. Outcome of 134 neonates with MMC is reported. Hydrocephalus was seen in 88 (65.7%), Chiari type II malformation in 84 (62.7%), orthopedic anomaly in 41 (30.6%), rib anomaly in 17 (12.7%), kyphosis in 26 (19.4%), and scoliosis in 5 (11.2%) neonates. 59 (44.0%) neonates underwent MMC surgery in < 48 h. Wound dehiscence/cerebrospinal fluid (CSF) discharge at the MMC repair site occurred in 5 (8.5%) neonates; only 2 (3.4%) had CNS infection. Late (> 48 h) repair was performed on 75 (55.9%) neonates. 6(8%) neonates experienced wound dehiscence/CSF discharge, and 8 (10.7%) developed CNS infection. Kyphectomy was performed on 9/26 (34.6%) neonates. Prognostic factors for kyphectomy included pregnancy number of MMC neonate (p = 0.049), postpartum MMC repair day (p = 0.027), number of previous operations (p < 0.001), presence and number of concurrent surgeries (p < 0.001 and p < 0.001, respectively), and history of Chiari II operation (p = 0.002). The prognosis for neonates with MMC is primarily determined by the effective surgical and medical management of associated deformities and conditions, such as kyphosis, hydrocephalus, and Chiari type II malformation, rather than the timing of MMC sac repair (early vs. delayed surgery). The decision-making process regarding the timing and technique of corrective surgeries should focus on the severity of symptoms related to Chiari II malformation and kyphosis in the neonate rather than their radiologic presence.