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Jeffrey P. Blount, Kent B. Remley, Samuel K. Yue and Donald L. Erickson

patient's neurological status improved and he now ambulates with a walker. Routine aerobic cultures were negative. Histological evaluation of the mass revealed homogeneous dense granulomatous inflammation with rare areas of necrosis. Case 2 History This 64-year-old woman suffered chronic dysesthetic pain in her lower extremities. After the failure of conservative management, use of a subdural catheter and infusion pump was instituted. Pain control was obtained with administration of 12 to 14 mg of morphine sulfate per day. Examination A new type of

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R. Shane Tubbs, John C. Wellons III, Jason Banks, Jeffrey P. Blount and W. Jerry Oakes

specimens (35.7%) the transverse ligament in a nonpathological state provides limited stability for the atlantoaxial juncture. Considering this area's unique embryological derivation, we would hypothesize that these tubercles merely represent lateral extensions of the transverse ligament (proatlantal unossified tissue 16 ) that do not undergo soft-tissue transformation and are not typical osseous protuberances produced by the chronic pull of tendinous/ligamentous attachments. Our findings that 17 tubercles (14.7%) did not protrude from the lateral masses into the

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R. Shane Tubbs, Matthew D. Smyth, John C. Wellons III, Jeffrey P. Blount, Paul A. Grabb and W. Jerry Oakes

, which begins during the 1st year of life, and incomplete ossification of the apical odontoid epiphysis. Flexion of the cervical spine tends to increase the ADI. 4, 5 The ADI is also of limited value when evaluating chronic atlantoaxial instability due to, for example, congenital anomalies such as os odontoideum and juvenile rheumatoid arthritis. 4 Naidich, et al., 9 have proposed that for anterior cervical dislocation that the interspinous distance in flexion at any cervical level should not be greater than 1.5-fold of that at both the level above and below the

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Matthew D. Smyth, R. Shane Tubbs, E. Martina Bebin, Paul A. Grabb and Jeffrey P. Blount

electroencephalographic activation induced by VNS in animals. Because highly synchronized patterns are characteristic of seizures on electroencephalography, 36 such studies of brain wave rhythmicity form the neuroanatomical and neurophysiological basis for the hypothesis that appropriately timed stimulation of the vagus nerve blunts paroxysmal epileptiform activity. 42 With data from the aforementioned studies providing a framework for the initiation of trials of chronic vagal stimulation in humans, VNS has emerged during the past decade as a viable surgical option for treating

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R. Shane Tubbs, John C. Wellons III, Jeffrey P. Blount, W. Jerry Oakes and Paul A. Grabb

P atients with Chiari I malformation can present with a variety of symptoms, although headaches are a common presentation. Cardiovascular compromise, especially in the young patient, is seemingly rare in this form of hindbrain herniation. Hypertension has previously been treated by microvascular decompression of the brainstem, but results have varied. 3, 8–10, 15 We report on a child with preoperative chronic idiopathic hypertension that resolved after decompressive surgery for Chiari I malformation. Case Report History and Presentation This 16-year

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Jeffrey P. Blount, Wayne Langburt, Hiroshi Otsubo, Shiro Chitoku, Ayako Ochi, Shelly Weiss, O. Carter Snead and James T. Rutka

, Otsubo H , Harada Y , et al : Extraoperative cortical stimulation of motor function in children. Pediatr Neurol 24 : 344 – 350 , 2001 Chitoku S, Otsubo H, Harada Y, et al: Extraoperative cortical stimulation of motor function in children. Pediatr Neurol 24: 344–350, 2001 4. Davies KG , Weeks RD : Results of cortical resection for intractable epilepsy using intra-operative corticography without chronic intracranial recording. Br J Neurosurg 9 : 7 – 12 , 1995 Davies KG, Weeks RD: Results of

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R. Shane Tubbs, John C. Wellons III, Jeffrey P. Blount, Paul A. Grabb and W. Jerry Oakes

) the peritoneal tubing was shortened. None of the three patients has continued to experience shoulder pain. In each patient the chronic shoulder pain, which had a mean duration of 4 months, ceased immediately following shunt revision. Illustrative Case History This 16-year-old boy had a history of prematurity and posthemorrhagic hydrocephalus. He had undergone two previous right-sided VP shunt revisions for headache. Both of these procedures found intracranial catheter occlusion as the cause of the shunt malfunction. Examinations The patient

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R. Shane Tubbs, John C. Wellons III, Jeffrey P. Blount, Paul A. Grabb and W. Jerry Oakes

) the peritoneal tubing was shortened. None of the three patients has continued to experience shoulder pain. In each patient the chronic shoulder pain, which had a mean duration of 4 months, ceased immediately following shunt revision. Illustrative Case History This 16-year-old boy had a history of prematurity and posthemorrhagic hydrocephalus. He had undergone two previous right-sided VP shunt revisions for headache. Both of these procedures found intracranial catheter occlusion as the cause of the shunt malfunction. Examinations The patient

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R. Shane Tubbs, John C. Wellons III, Jeffrey P. Blount and W. Jerry Oakes

operative intervention, follow-up head CT scans revealed an interval decrease in ventricular size, and the patient became asymptomatic ( Fig. 1 ). This patient has now been asymptomatic for 7 months. Discussion Urinary tract complications such as infection, ureteral reflux, upper tract dilation, and incontinence are common in patients born with a myelomeningocele. 1 Most children suffering from myelodysplasia have chronic urinary bladder infections that are frequently subclinical and are treated prophylactically. Szucs, et al., 5 found that in 43 asymptomatic

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R. Shane Tubbs, John C. Wellons III, Jeffrey P. Blount and W. Jerry Oakes

operative intervention, follow-up head CT scans revealed an interval decrease in ventricular size, and the patient became asymptomatic ( Fig. 1 ). This patient has now been asymptomatic for 7 months. Discussion Urinary tract complications such as infection, ureteral reflux, upper tract dilation, and incontinence are common in patients born with a myelomeningocele. 1 Most children suffering from myelodysplasia have chronic urinary bladder infections that are frequently subclinical and are treated prophylactically. Szucs, et al., 5 found that in 43 asymptomatic