The patient is positioned prone, with the head rotated laterally as close to 90 degrees as possible. The body is positioned over a rolled towel, with the placode at the apex of the towel to avoid CSF leakage into unwanted areas.

A midline linear incision from top of placode to distal 2 normal vertebrae is created. 

A circumferential incision—surrounding placode at the border of normal skin and arachnoid membrane—is created.

Using microdissectors and microscissors, delicate dissection of the placode from the normal anatomy is completed. Care should be taken to avoid the dorsal and ventral roots which are often immediately adjacent to the placode.

Vessels and smaller non-functional nerves within the placode can be carefully freed to prepare for the next steps.

This step is considered the “reconstruction of the neural tube.” The placode at the bottom of the dural sac (which continues rostrally with the intact cord) has spinal roots emerging ventrally. The two lateral edges of placode are brought midline and sutured. Avoid excessive tight closures. If closure cannot be achieved then skip step.