The aim of this study is to review the literature and recent publications regarding the management of myelomeningocele.myelomeningocele. is the most common and complex presentation of neural tube closure defects with wide range of management modalities as regarding the association with Chiari malformation type II and hydrocephalus ,the need for shunt placement and its timing and the ideal method for closure of the defect.In this study we tried to clarify the best methods and timing to deal with myelomeningocele. and the associated hydrocephalus as well as to reduce the risk of post operative wound breakdown with associated CSF leakage and subsequent serious infection other possible complications and the final outcome.The study was done prospectively on 20 cases of myelomeningocele ,of whom 6 cases were operated upon by v-p shunt before presenting to us,10 cases were presented with associated hydrocephalus and were managed accordingly and 4 cases were presented without evident hydrocephalus of whom 1 case required shunt placement and the other 3 cases were followed -up and did not require CSF diversion. Despite the size of the defect of the myelomeningocele ,primary skin closure was efficient in restoration of the skin contour sometimes helped by more lateral dissection or lateral releasing incision with limited role for skin flaps and grafts.