Mesencephalic spur (beaking deformity of the tectum) in Arnold-Chiari malformation

1976 ◽  
Vol 45 (3) ◽  
pp. 315-320 ◽  
Author(s):  
Adelola Adeloye
Keyword(s):  
Chiari Malformation ◽  
Type Ii ◽  
Content Type ◽  
Arnold Chiari Malformation ◽  
Degrees Of Severity ◽  
Fine Print

✓ The beaking deformity of the tectum, referred to in this paper as the mesencephalic spur, is regularly present in the Type II variety of the Arnold-Chiari malformation in varying degrees of severity. When the mesencephalic spur is related to associated myelomeningocele, it was found that the more extensive the myelomeningocele, and the older the affected children, the more prominent was the mesencephalic spur.

Experience with Arnold-Chiari malformation, 1960 to 1970

1976 ◽  
Vol 45 (4) ◽  
pp. 416-422 ◽  
Author(s):  
Ruben J. Saez ◽  
Burton M. Onofrio ◽  
Takehiko Yanagihara
Keyword(s):  
Retrospective Study ◽  
Neurological Deficit ◽  
Chiari Malformation ◽  
Prognostic Significance ◽  
Cerebellar Dysfunction ◽  
Content Type ◽  
Arnold Chiari Malformation ◽  
Clinical Syndromes ◽  
Suboccipital Decompression ◽  
Fine Print

✓ A retrospective study of 60 adult patients with Arnold-Chiari malformation revealed that certain presenting clinical syndromes, although not pathognomonic, seemed to have definite prognostic significance. Surgical management by suboccipital decompression led to remarkable and enduring improvement in 65% of patients followed for as long as 14 years. In some patients, however, the initial postoperative benefit tended to fade into an insidious progression of neurological deficit. Despite operation, 18.6% of patients eventually experienced progressive neurological deterioration. Patients who presented with paroxysmal intracranial hypertension or cerebellar dysfunction had the best prognosis. Evidence of central cord involvement was the single most detrimental factor to neurological recovery.

Myelomeningocele before birth

1978 ◽  
Vol 49 (5) ◽  
pp. 711-724 ◽  
Author(s):  
Kunihiko Osaka ◽  
Takashi Tanimura ◽  
Akihiko Hirayama ◽  
Satoshi Matsumoto
Keyword(s):  
Spinal Cord ◽  
Chiari Malformation ◽  
Cervical Cord ◽  
Human Embryos ◽  
Content Type ◽  
Fetal Period ◽  
Arnold Chiari Malformation ◽  
Spina Bifida Cystica ◽  
Almost All ◽  
Fine Print

✓ The authors report a study of 92 human embryos and four fetuses with myeloschisis. The characteristics of embryonic myeloschisis compared with spina bifida cystica in infants are: 1) the lesion is often more diffuse, involving the whole spinal cord (12 embryos); 2) the cervical cord is more frequently affected (23 of the remaining 80 embryos); 3) holoprosencephaly is frequently associated (18 embryos); 4) meningocele is not found; and 5) hydrocephalus and Arnold-Chiari malformation are not yet developed. Hydrocephalus and Arnold-Chiari malformation are found in myeloschistic fetuses. Almost all embryos with diffuse and cervical myeloschisis or with holoprosencephaly are extruded before birth by spontaneous abortion. Absence of meningocele in the embryonic period implies that its appearance is deferred to the fetal period. The development of hydrocephalus and Arnold-Chiari malformation also seems to be delayed until the fetal period. Our observation implies that myelomeningocele is induced by non-closure of the neural tube, not by rupture once it was closed. “Neural overgrowth” and disturbed “recanalization process” are discussed in relation to the pathogenesis of myelomeningocele.

Malignant hyperthermia

1977 ◽  
Vol 46 (3) ◽  
pp. 385-390 ◽  
Author(s):  
Jeffery L. Rush ◽  
Eldon L. Foltz
Keyword(s):  
Metabolic Acidosis ◽  
Malignant Hyperthermia ◽  
Chiari Malformation ◽  
Tissue Hypoxia ◽  
Content Type ◽  
Arnold Chiari Malformation ◽  
Noncommunicating Hydrocephalus ◽  
Unusual Problem ◽  
Fine Print

✓ The authors report the case of an infant with noncommunicating hydrocephalus, Arnold-Chiari malformation, and a lumbar myelomeningocele, in whom malignant hyperthermia occurred. The genetics and presumed etiology of this unusual problem are reviewed. The management is directed toward establishing effective cooling measures, reversing tissue hypoxia, and correcting respiratory and metabolic acidosis.

Communication of hydromyelic cavity with the fourth ventricle shown by combined Pantopaque and air myelography

1973 ◽  
Vol 38 (2) ◽  
pp. 235-238 ◽  
Author(s):  
Hector E. James ◽  
Luis Schut ◽  
Patrick P. Pasquariello
Keyword(s):  
Respiratory Distress ◽  
Chiari Malformation ◽  
Fourth Ventricle ◽  
Radiological Evaluation ◽  
Content Type ◽  
Feeding Difficulties ◽  
Arnold Chiari Malformation ◽  
Fine Print

✓ A 3-year-old child who had had respiratory and feeding difficulties at birth was admitted because of respiratory distress and stridor. Radiological evaluation with Pantopaque and air myelography revealed an Arnold-Chiari malformation associated with extensive hydromyelia and communication between the fourth ventricle and the hydromyelic cavity.

The relationship of Arnold-Chiari and Dandy-Walker malformations

1972 ◽  
Vol 36 (4) ◽  
pp. 481-486 ◽  
Author(s):  
W. James Gardner ◽  
J. Lawton Smith ◽  
Dorcas H. Padget
Keyword(s):  
Posterior Fossa ◽  
Chiari Malformation ◽  
Content Type ◽  
Arnold Chiari Malformation ◽  
Dandy Walker Malformation ◽  
Walker Malformation ◽  
Relationship Of ◽  
The Relationship ◽  
Fine Print

✓ The posterior fossa is abnormally small in cases of Arnold-Chiari malformation because the tentorium is too low, whereas it is abnormally large in the Dandy-Walker malformation because the tentorium is too high.

Split spinal cord malformations in children

1998 ◽  
Vol 88 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Yusuf Ersşahin ◽  
Saffet Mutluer ◽  
Sevgül Kocaman ◽  
Eren Demirtasş
Keyword(s):  
Spinal Cord ◽  
Neurological Deficits ◽  
Single Type ◽  
Type I ◽  
Type Ii ◽  
Content Type ◽  
Spinal Lesion ◽  
The Mean ◽  
Fine Print

Object. The authors reviewed and analyzed information on 74 patients with split spinal cord malformations (SSCMs) treated between January 1, 1980 and December 31, 1996 at their institution with the aim of defining and classifying the malformations according to the method of Pang, et al. Methods. Computerized tomography myelography was superior to other radiological tools in defining the type of SSCM. There were 46 girls (62%) and 28 boys (38%) ranging in age from less than 1 day to 12 years (mean 33.08 months). The mean age (43.2 months) of the patients who exhibited neurological deficits and orthopedic deformities was significantly older than those (8.2 months) without deficits (p = 0.003). Fifty-two patients had a single Type I and 18 patients a single Type II SSCM; four patients had composite SSCMs. Sixty-two patients had at least one associated spinal lesion that could lead to spinal cord tethering. After surgery, the majority of the patients remained stable and clinical improvement was observed in 18 patients. Conclusions. The classification of SSCMs proposed by Pang, et al., will eliminate the current chaos in terminology. In all SSCMs, either a rigid or a fibrous septum was found to transfix the spinal cord. There was at least one unrelated lesion that caused tethering of the spinal cord in 85% of the patients. The risk of neurological deficits resulting from SSCMs increases with the age of the patient; therefore, all patients should be surgically treated when diagnosed, especially before the development of orthopedic and neurological manifestations.

scholarly journals Intravenous Sedation in Arnold-Chiari Malformation With Respiratory Failure

2019 ◽  
Vol 66 (1) ◽  
pp. 37-41 ◽  
Author(s):  
Yoshiki Shionoya ◽  
Eishi Nakamura ◽  
Takahiro Goi ◽  
Kiminari Nakamura ◽  
Katsuhisa Sunada
Keyword(s):  
Respiratory Failure ◽  
Respiratory Depression ◽  
Chiari Malformation ◽  
Dental Treatment ◽  
Anesthetic Management ◽  
Cranial Nerves ◽  
Intravenous Sedation ◽  
Type Ii ◽  
Neck Extension ◽  
Arnold Chiari Malformation

Type II Arnold-Chiari malformation (ACM) is an abnormality in which the cerebellum, pons, and medulla oblongata are displaced downward into the spinal cord. Type II ACM is often complicated by respiratory depression, sleep-disordered breathing, and deglutition disorder as a result of medullary dysfunction and impairment of the lower cranial nerves. Bending and stretching of the neck is restricted, and anesthetic management is problematic in patients with the disorder. We performed dental treatment twice under intravenous sedation in a patient with intellectual disability with type II ACM complicated by hypercapnic respiratory failure. Propofol was used for the first sedation procedure. Repeated bouts of respiratory depression occurred on that occasion, so the airway was managed manually by lifting the jaw. However, aspiration pneumonitis occurred postoperatively. A combination of dexmedetomidine and midazolam was used for sedation on the second occasion, and the intervention was completed uneventfully without any respiratory depression. Our experience with this patient highlights the need for selection of an agent for intravenous sedation that does not require neck extension and has minimal effect on respiration in patients with type II ACM, who are at high risk of respiratory depression and pulmonary aspiration.

Posterior petrous meningiomas: 82 cases

2005 ◽  
Vol 102 (2) ◽  
pp. 284-289 ◽  
Author(s):  
Zhe Bao Wu ◽  
Chun Jiang Yu ◽  
Shu Sen Guan
Keyword(s):  
Facial Nerve ◽  
Clinical Manifestations ◽  
Petrous Bone ◽  
Type I ◽  
Type Ii ◽  
Posterior Surface ◽  
Total Resection ◽  
Content Type ◽  
Functional Preservation ◽  
Fine Print

Object. The aim of this study was to discuss posterior petrous meningiomas—their classification, clinical manifestations, surgical treatments, and patient outcomes. Methods. A retrospective analysis was performed in 82 patients with posterior petrous meningiomas for microsurgery. According to the anatomical relationship with the posterior surface of the petrous bone and with special reference to the internal auditory canal (IAC), posterior petrous meningiomas were classified into three types: Type I, located laterally to the IAC (28 cases); Type II, located medially to the IAC, which might extend to the cavernous sinus and clivus (32 cases); and Type III, extensively attached to the posterior surface of the petrous bone, which might envelop the seventh and eighth cranial nerves (22 cases). Sixty-eight (83%) of 82 cases involved total resection. The rate of anatomical preservation of facial nerve was 97.5%, whereas the functional preservation rate was 81%. The rate of hearing preservation was 67%. All Type I tumors were completely resected, and the rate of anatomical preservation of facial nerve was 100% and functional preservation was 93%. Regarding Type II lesions, 75% of 32 cases involved total resection; the rate of anatomical preservation of facial nerve was 97% and functional preservation was 75%. For Type III lesions, 73% of 22 cases were totally resected. The rate of anatomical preservation of facial nerve in patients with this tumor type was 95%, whereas functional preservation was 73%. Conclusions. Clinical manifestations and surgical prognoses are different among the various types of posterior petrous meningiomas. It is more difficult for Types II and III tumors to be resected radically than Type I lesions, and postoperative functional outcomes are significantly worse accordingly. The primary principles in dealing with this disease entity include preservation of vital vascular and central nervous system structures and total resection of the tumor as much as possible.

Symptomatic Arnold-Chiari malformation: review of experience with 22 cases

1987 ◽  
Vol 66 (6) ◽  
pp. 812-816 ◽  
Author(s):  
William O. Bell ◽  
Edward B. Charney ◽  
Derek A. Bruce ◽  
Leslie N. Sutton ◽  
Luis Schut
Keyword(s):  
Chiari Malformation ◽  
Complete Resolution ◽  
Older Patients ◽  
Surgical Decompression ◽  
Complete Relief ◽  
Content Type ◽  
Arnold Chiari Malformation ◽  
Feeding Difficulty ◽  
Symptoms And Signs ◽  
Chiari Malformations

✓ Twenty-two patients with closed myelomeningoceles, shunted hydrocephalus, and symptomatic Arnold-Chiari malformations were studied retrospectively. Seventeen of the 22 patients were aged 6 months or younger; five patients were aged 3 to 23 years. Patients in the younger group presented with stridor, apnea, and/or feeding difficulty; those in the older group presented with hemiparesis, quadriparesis, oscillopsia, nystagmus, or opisthotonos. Fourteen of the 17 younger patients underwent surgical decompression of the Arnold-Chiari malformation: 10 within 18 days following the onset of symptoms and four on Day 19 or later. Of the 10 infants with early treatment, five eventually died secondary to continued symptoms and five survived. Of those surviving, three were asymptomatic and two had continuing symptoms but were improved over their preoperative state. Among the four patients undergoing surgery later, two died, one had lessening of stridor, and one had complete relief of symptoms. Of the three infants not undergoing decompression, two died and one eventually became asymptomatic. All five of the older patients underwent decompression and all had complete resolution of their preoperative symptoms and signs. The authors conclude that while decompression of a symptomatic Arnold-Chiari malformation may be effective in children and adults, this treatment does not always improve the clinical condition of infants. This may be the result of ischemic/hypoxic effects on the infant's brain stem, which may not be organized normally at birth.

Acute axis fractures: a review of 229 cases

1989 ◽  
Vol 71 (5) ◽  
pp. 642-647 ◽  
Author(s):  
Mark N. Hadley ◽  
Curtis A. Dickman ◽  
Carol M. Browner ◽  
Volker K. H. Sonntag
Keyword(s):  
Treatment Guidelines ◽  
Type Ii ◽  
High Likelihood ◽  
Fracture Feature ◽  
Content Type ◽  
Nonoperative Therapy ◽  
The Difference ◽  
Cervical Spine Fractures ◽  
Fine Print

✓ Eighteen percent of acute cervical spine fractures involve the C-2 vertebra. The odontoid Type II fracture is the most common axis fracture and it is also the most difficult to treat. The degree of odontoid dislocation has been identified as the single most important fracture feature that helps separate those patients who have a high likelihood of healing with nonoperative therapy from those who are likely to fail nonoperative therapy and should be offered early surgical stabilization. The difference is statistically significant (p < 0.001, x2 = 30.20). The present series includes 229 patients with acute axis fractures. Follow-up data were available in 92% of these patients, for a median duration of 4 years 9 months. Treatment guidelines and results are offered for each subtype of axis fracture based on this experience.

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