Background: the prognosis of Terminal lipomas is better than that of other sites and pathology especially their management nowadays became clearer with better surgical outcome due to advancement of surgical tools and neurophysiology study. Objective: to assess the outcome of excision of terminal lipomyelomeningocele and reconstruction of the neural tube. Methods: From 2002 to 2016, 32 cases of terminal lipomyelomeningocele in Mansoura university hospital, insurance hospital and El Ahrar specialized center, the age of the cases ranged between 10 days and 4,3 years underwent surgical management of total or near-total lipoma excision and neural tube reformation with minimum follow up of 6 months. Results: according to system which applied to show the success of the operations, Of the 32 patients, 9 cases represent (28.1%) showed total excision of the lipoma; 17 patients represent (53.1%) had 25 mm3 of lipoma or less and 6 patients represent (18.75%) had 26 mm3 of fat or more. The neurological and urological complications was about 25%, while other complications like cerebrospinal fluid leak, wound disruption and infection was 9.4%. The surgical morbidity was comparable with the published papers. Conclusion: the excision of terminal lipomyelomeningocele and recreation of the neural tube by monitoring throughout EMG & NCV with low surgical morbidity and better results than leaving them without management or surgical interference without neurophysiological monitoring. Key words: terminal lipomyelomeningocele, lipoma, Reconstruction of neural placode. Abbreviations: DREZ, dorsal root entry zone; MRI, magnetic resonance imaging, CSF, cerebrospinal fluid.