In a previous article1I emphasized that spina bifida is primarily an expression of inadequate or improper fusion of the embryonal tissues in the dorsal median region of the developing embryo and the resultant pathologic states are manifested, therefore, in the cutaneous, mesodermal and/or neural derivatives of these tissues. Since to many the term spina bifida indicates a vertebral defect (posteriorly through the arch or anteriorly through the bodies of the vertebrae or through the sacrum), and since in many instances anomalies, particularly neural in nature, belonging to the spina bifida group of disorders occur unassociated with evidences of a bony defect, the generic term "spinal dysraphism" was used to identify these conditions resulting from defective raphe formation. In that study the cutaneous, vertebral, meningeal and neural manifestations of the dysraphic state were described. Just as important, however, are the pleomorphic neuroanatomic changes in distant parts of the nervous