This report of our experience with 1,201 cerebrospinal fluid shunt procedures over a 17-year period includes two time periods: from 1965 to 1974 and from 1975 to 1982. The overall operative infection rate fell from 10.7% in the former period to 3.6% in the latter period. The overall average number of revisions fell from 1.8 to 0.77. The number of revisions for patients with infected shunts in the latter period was 4.07. Three hundred and eighty-four shunts were studied in the latter period for the effects of prophylactic antibiotics. No significant difference was found between the infection rate of 5.6% in the nonantibiotic group and the infection rate of 2.1% in the group receiving intravenous and intraventricular methicillin and gentamicin. Differences in the operative infection rates for patients with and without meningomyelocele and those operated on by different surgeons were not significant. The only mortalities were from nonoperative and noncerebrospinal fluid shunt causes.

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14 years experience with 354 infants born with myelomeningocele are reviewed in view of prelabor and pre-rupture of amniotic membranes vs vaginal delivery or delivery by cesarian section after labor and rupture of amniotic membrane. The apparent lack of effect of severity of impairment determined by prenatal diagnosis on parental decision to carry their baby to term, the negative effect on motor function of kyphos or congenital kyphoscoliosis, the equivocal effect of breech presentation with or without rupture of amniotic membranes and the beneficial effect of prelabor and prerupture of membranes delivery of selected infants is discussed. The need for further multiple center, collaborative study to identify the contribution of a number of factors influencing the outcome of fetuses diagnosed as having myelomeningocele is emphasized.