By C. Sainte-Rose As we stand at the dawn of the 21st century, one may ponder the rationale of writing a book on spina bifida. Once commonplace in European countries prior to the era of ultrasonography, this disease became increasingly rare in developed countries as a - sult of improvements in antenatal diagnosis, to the point that we believed it to be d- appearing. Knowledge of spina bifida and of its treatment, once so richly diffused - ly 30 years ago, began to fade. Young neurosurgeons who had never seen such a m- formation at its initial presentation were hesitant, and did not understand the protean clinical signs of these patients presenting to the emergency department or outpatient clinics. This situation, however, did not last for long. As a consequence of the poli- cal and economic events of the final years of the 20th century, the advent of globa- sation, and the significant desire for immigration, we realised that spina bifida had not disappeared at all in the rest of the world. Migration was, and is, bringing it back - to our doorstep, to our everyday clinical and surgical practice. It is important the- fore, not to lose the knowledge gained by our masters, to try and assemble it in one place in order to understand the disease from its inception in utero through until adu- hood and the reproductive age.
The evolution of technology has made new surgical techniques available for the treatment of diseases associated with the spina bifida malformation, and this is especially true in hydrocephalus and fetal surgery. The progress in this last field and in prenatal diagnosis have raised the significant problem of the effectiveness and usefulness of in utero surgical treatment of the malformation, that are extensively discussed in this volume. Also the clinical situations that can be seen in adolescents or young adults with spina bifida, including sexuality and pregnancy, are highlighted. Aim of this book is to promote a multidisciplinary approach to spina bifida, providing the three main specialists' categories involved - neurosurgeons, orthopaedic surgeons, and urologists - with an updated overview of surgical approaches and with a concise reference that explains the main clinical problems to be faced in everyday clinical practice.
