Of the 171 children with myelomeningocele referred to the Children's Hospital of Philadelphia in a six-year period, 33 died, 23 were not available for follow-up, and 115 have been followed for three to eight years. In the 79 children whose hydrocephalus required shunt operation, 42% with thoracal lumbar lesion and 80% with lumbar and lumbosacral lesions are ambulatory and competitive with a Developmental or Intelligent Quotient of 80 or higher. In the 35 children not requiring such surgery, 90% are ambulatory and competitive. These results have been obtained by employing a simple but comprehensive and coordinated plan of treatment shared by the neurosurgeon and pediatrician with extensive use of paramedical personnel in the actual care of the child. Other doctors are used only as consultants and not in primary decision-making. Because no infallible criteria for determining potential at birth have evolved, all children are operated upon to close the defects and relieve the hydrocephalus.