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Matthew B. Potts, Jau-Ching Wu, Nalin Gupta and Praveen V. Mummaneni

open diastematomyelia w/ TC, after previous detethering operation as a child diastematomyelia w/ fibrous band btwn hemicords; scoliosis; no lipoma 3 63 200 4 12 open TC, after previous lipoma resection & previous detethering as a child intradural lipoma; fatty filum mean 43.3 300 7 4 † 37 100 7 3 mini-open TC fatty filum; no lipoma 5 55 200 7 15 mini-open diastematomyelia w/ TC diastematomyelia w/ fibrous band btwn hemicords; syringomyelia w/in conus & distal spinal cord; subcutaneous lumbosacral

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Paul Steinbok, Hugh J. L. Garton and Nalin Gupta

comfort level with the surgical procedure, a more liberal view of how tethering of the cord might occur, or a combination of both. These results indicate that sufficient clinical equipoise exists to justify ethically a randomized clinical trial for patients having a normally positioned conus and normal-appearing terminal filum; inclusion of patients with syringomyelia in such a trial could also be justified if desired. Additional debate may be needed with regard to the inclusion of patients with fatty fila, as only 6% of respondents absolutely disagreed that

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Shokei Yamada and Daniel J. Won

Pediatrics): 309–313, May, 2006). Each article offers a unique approach to TCS in patients with the chief complaint of incontinence. According to Steinbok and colleagues statistics on patients with motor and sensory deficits and incontinence, divided opinions exist with respect to the use of surgical untethering in those patients without well-known features, such as an elongated cord, 6 a thick or fatty terminal filum, and syringomyelia. Selden justifies untethering in patients with incontinence only and no evidence of any other anomaly, 4 and he agrees with the

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Noel Tulipan, John C. Wellons III, Elizabeth A. Thom, Nalin Gupta, Leslie N. Sutton, Pamela K. Burrows, Diana Farmer, William Walsh, Mark P. Johnson, Larry Rand, Susan Tolivaisa, Mary E. D’alton and N. Scott Adzick

qualify); b) bulging fontanelle (assessed when the baby was in an upright position and not crying) or split sutures or sunsetting sign; c) increasing hydrocephalus on consecutive imaging studies determined by an increase in ratio of biventricular diameter to biparietal diameter according to the method of O’Hayon et al.; 9 or d) head circumference > 95th percentile for gestational age. Criteria 2, 3, and 4 were the presence of marked syringomyelia with ventriculomegaly, ventriculomegaly with symptoms of Chiari malformation (stridor, swallowing difficulties, apnea

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Introduction Chiari I malformations (CMI) often present with syringomyelia (SM). Successful surgical treatment of the CMI leads to improvement in both the symptoms as well as the SHM. Persistent SM after decompression has been described, and conservative management may allow for improvement over time. We present three children, who after decompression had enlargement of their SM without further symptoms. Delayed imaging on these patients revealed decrease in the SM, to sizes smaller than those seen preoperatively. Methods