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Sandi Lam, Ramesh Grandhi and Stephanie Greene

of C-3 and syringomyelia distal to that point ( Fig. 2 ). At 2.5 weeks of life, the patient underwent CM-II decompression, with a C1–5 laminectomy and duraplasty. Meconium staining of the arachnoid and subarachnoid spaces at the inferior aspect of the brainstem was noted intraoperatively ( Fig. 3 ). No attempt was made to remove this because dissecting material off of the brainstem would carry a high risk of neurological morbidity; moreover, the presence of meconium throughout the cervicothoracolumbar spine was presumed since the entry point was the open lumbar

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Kimberly A. Foster, Sandi Lam, Yimo Lin and Stephanie Greene

SR , Maher CO : The outcome of tethered cord release in secondary and multiple repeat tethered cord syndrome. Clinical article . J Neurosurg Pediatr 4 : 28 – 36 , 2009 3 Beaumont A , Muszynski CA , Kaufman BA : Clinical significance of terminal syringomyelia in association with pediatric tethered cord syndrome . Pediatr Neurosurg 43 : 216 – 221 , 2007 4 Bowman RM , McLone DG , Grant JA , Tomita T , Ito JA : Spina bifida outcome: a 25-year prospective . Pediatr Neurosurg 34 : 114 – 120 , 2001 5 Bowman RM , Mohan A

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Gurpreet S. Gandhoke, Sabri Yilmaz, Lorelei Grunwaldt, Ronald L. Hamilton, David J. Salvetti and Stephanie Greene

foramina on the right. Her chief complaint was relieved after the second surgery, though significant hemorrhage and a right Horner syndrome complicated this intervention. In addition, the MRI showed an (at that time) incidental finding of a Chiari I malformation with descent of the cerebellar tonsils by 9 mm ( Fig. 1A ). There was no associated syringomyelia or other intracranial abnormality. She developed exertional headaches and nuchal pain in 2005 ( Fig. 1B ) and underwent a Chiari decompression (3-cm suboccipital craniectomy, C-1 laminectomy, and generous duraplasty

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Michael M. McDowell, Jason E. Blatt, Christopher P. Deibert, Nathan T. Zwagerman, Zachary J. Tempel and Stephanie Greene

postoperatively. Fourth ventricular–subarachnoid or subarachnoid-peritoneal shunts were placed for persistent syringomyelia in a second decompressive surgery after an initial CM-II decompression did not succeed in reducing the size of the syrinx. Definitions The size of the myelomeningocele defect was defined as the largest diameter of the skin defect in centimeters measured at the time of closure. The diagnosis of hydrocephalus was made by identifying a rapidly increasing head circumference crossing percentiles on the growth chart for gestational age and progressive

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Jason S. Hauptman, Robert Bollo, Rama Damerla, Brian Gibbs, Cecilia Lo, Aviva Katz and Stephanie Greene

mild ventricular enlargement and a Chiari II malformation, without evidence of syringomyelia. The child recovered well from both surgeries, was extubated, was able to tolerate enteral feeding by day 9 of life, and was discharged from the hospital 15 days after birth without further complications. During the hospitalization, biweekly ultrasound studies failed to reveal significant ventricular enlargement, and the head growth velocity was not abnormal. On last follow-up at 3 months of age, the patient has an L-4 functional level with weakness in dorsiflexion and

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Robert Kellogg, Philip Lee, Christopher P. Deibert, Zachary Tempel, Nathan T. Zwagerman, Christopher M. Bonfield, Stephen Johnson and Stephanie Greene

group. Twenty-eight patients in our study underwent CM-II decompression. The indications for this procedure were similar to those in other published studies, as was the percentage of patients who improved neurologically following surgery. 1 , 19 While this procedure was historically considered to be controversial, more recent data have supported early and aggressive decompression. 22 , 23 Interestingly, the preoperative finding that was least likely to improve in this series is syringomyelia, whereas other groups have found this to respond well to decompression. 19