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Benjamin C. Kennedy, Taylor B. Nelp, Kathleen M. Kelly, Michelle Q. Phan, Samuel S. Bruce, Michael M. McDowell, Neil A. Feldstein and Richard C. E. Anderson

center and a relatively short follow-up. However, the favorable clinical outcomes and radiographic improvement reported in this study suggest that the presence of a syrinx should not be considered a contraindication to PFD without dural opening. Furthermore, this study demonstrates that delayed improvement of syringomyelia after PFD without dural opening should be expected and is not an independent indication for reoperation. We look forward to future studies investigating similar questions that will have increased power and granularity generated from collaborative

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Benjamin C. Kennedy, Kathleen M. Kelly, Michelle Q. Phan, Samuel S. Bruce, Michael M. McDowell, Richard C. E. Anderson and Neil A. Feldstein

the dura during PFD in patients with syringomyelia to address possible arachnoid adhesions obstructing outflow of the fourth ventricle. We believe that the frequency of intradural adhesions is low because we did not see this in any of the 68 syrinx patients in this study. In the 8 patients in this series who underwent reoperation for recurrent symptoms with syringomyelia, no arachnoid adhesions obstructing CSF flow were seen. During the follow-up period of just over 2.5 years, more 50% of the syringes in our series were less than half of their original size. Only 4

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Zachary L. Hickman, Michael M. McDowell, Sunjay M. Barton, Eric S. Sussman, Eli Grunstein and Richard C. E. Anderson

progressive quadriparesis, respiratory disturbances during sleep CSF leak repaired w/ fat graft 2 Hankinson et al., 2010 * 15, M Chiari malformation Type I retroflexed odontoid process recurrent occipital headaches, hypernasal speech, palatal & swallowing dysfunction, loss of gag reflex, myelopathy none 3 — 11, F Chiari malformation Type I retroflexed odontoid process scoliosis, syringomyelia none 4 Tomazic et al., 2011 11, F Chiari malformation Type II retroflexed odontoid process myelopathy, syringomyelia none 5

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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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Nitin Agarwal, Ahmed Kashkoush, Michael M. McDowell, William R. Lariviere, Naveed Ismail and Robert M. Friedlander

hydrocephalus, and 1 case of syringomyelia. Shunt Revisions A total of 509 procedures were performed (431 programmable, 78 fixed), with a 6-month minimum follow-up. The shunt revision rate was 22% (94 of 431) for programmable pressure valves and 21% (16 of 78) for fixed pressure valves (HR 1.1 [95% CI 0.6–1.8]; Table 2 ). Indications for shunt revision included 37 valve failures (7%), 34 catheter failures (7%), 28 shunt infections (6%), 2 cases of shuntalgia (0.4%), 2 cases of integumentary shunt erosion (0.4%), and 5 cases of overshunting (1%). Two shunts (0.4%) were

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Nitin Agarwal, Ahmed Kashkoush, Michael M. McDowell, William R. Lariviere, Naveed Ismail and Robert M. Friedlander

hydrocephalus, and 1 case of syringomyelia. Shunt Revisions A total of 509 procedures were performed (431 programmable, 78 fixed), with a 6-month minimum follow-up. The shunt revision rate was 22% (94 of 431) for programmable pressure valves and 21% (16 of 78) for fixed pressure valves (HR 1.1 [95% CI 0.6–1.8]; Table 2 ). Indications for shunt revision included 37 valve failures (7%), 34 catheter failures (7%), 28 shunt infections (6%), 2 cases of shuntalgia (0.4%), 2 cases of integumentary shunt erosion (0.4%), and 5 cases of overshunting (1%). Two shunts (0.4%) were