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

the craniocervical junction does not correlate with the presence of syringomyelia in the Chiari I malformation and that this compression was seemingly due to a posteriorly oriented odontoid, not true basilar invagination. Our present results show that higher grades of odontoid angulation do indeed correlate with syringomyelia: a syrinx was apparent in 74% of patients with a Grade II or Grade III odontoid angulation. Of holocord syringes, 70% were demonstrated in patients with a Grade III odontoid angulation. Curiously, no single grade of odontoid angulation

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Bermans J. Iskandar, Gary L. Hedlund, Paul A. Grabb and W. Jerry Oakes

out occult tumor as a cause of syringohydromyelia. The craniocaudal extent, morphological appearance, width, and anteroposterior dimension of the syrinx were recorded. Cine MR Imaging In addition to standard spin-echo techniques, we performed cerebrospinal fluid (CSF) flow dynamic studies with the 2-D phase-contrast cine MR technique, which uses the motion-sensitive nature of MR imaging to demonstrate flow dynamics at the craniocervical junction. Normal CSF movement is relatively synchronous with arterial pulsations. 9, 13 We performed qualitative analysis

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R. Shane TUBBS, Charles Law, W. Jerry Oakes and Paul A. Grabb

age 7 days a VP shunt was placed. Three shunt malfunctions occurred, each preceded by severe emesis and irritability. A diagnosis of spastic quadriplegia was made when the patient was a toddler. A seizure disorder was also diagnosed, for which the patient receives Tegretol (100, 50, and 150 mg morning, noon, and night, respectively), and scoliosis was present with a thoracic convexity to the right. At 6 years of age the patient underwent MR imaging of the brain and craniocervical junction to ascertain the causes of his seizures ( Fig. 1 left ). At 8 years of age

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R. Shane Tubbs, George Salter, Paul A. Grabb and W. Jerry Oakes

from L-4 to the foramen magnum. The cut edges of the dura were tacked laterally with sutures. The brains of these specimens had previously been removed without disruption of the bony craniocervical junction, and the brainstems had been sectioned just cephalad to the decussation of pyramids. We then appreciated the fine anatomy of the denticulate ligaments and compared these findings with previously reported information. Forces needed to create tautness in the denticulate ligaments were measured in newtons with stresses applied anteriorly, posteriorly, laterally

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

children who were evaluated for craniocervical stability as part of their workup for a Chiari I malformation. Ages ranged from 16 months to 18 years (mean 9.1 years); there were 32 male and 42 female patients. All 74 children enrolled in this study were thought to have both normal architecture and motion of the craniocervical junction and cervical spine. The ILD was measured between the atlas and axis in all children. This distance was defined as that between a midpoint of the anterior cortex of the atlantal posterior arch and a midpoint of the anterior cortex of the