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Kris A. Smith and Harold L. Rekate

after intradural intramedullary surgical procedures in the cervical region. Magnetic resonance images were consistent with dorsal tethering of the spinal cord in each case; however, these studies were not read as such by the neuroradiologists. All patients experienced resolution of both pain and neurological complaints after undergoing surgical detethering and duraplasty. Case Reports Case 1 This 16-year-old girl had a history of Chiari I malformation and syringomyelia for 1 year prior to the current presentation. She had been treated with suboccipital

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Harold L. Rekate

canulation). J Neurosurg Sci 30: 47–53, 1986 3. Lapras C , Poirier N , Deruty R , Bret P , Jyeux O : [Catheterization of the sylvian aqueduct. Its present role in the surgical treatment of sylvian aqueduct stenosis of PCF tumors, and of syringomyelia.] Neurochirurgie 21 : 101 – 109 , 1975 (Fr) Lapras C, Poirier N, Deruty R, Bret P, Jyeux O: [Catheterization of the sylvian aqueduct. Its present role in the surgical treatment of sylvian aqueduct stenosis of PCF tumors, and of syringomyelia.] Neurochirurgie 21

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Louis J. Kim, Harold L. Rekate, Jeffrey D. Klopfenstein and Volker K. H. Sonntag

—C3 Oc—C5 halo required odontoidectomy good 81 2 15, M paresthesias, dysesthesias Oc—C2 Oc—C4 halo required odontoidectomy excellent 92 3 2.6, M ataxia, dysphagia, Oc—C4 Oc—C6 halo halo pin infection good 71  poor phonation 4 2.4, F neck pain, scoliosis, Oc—C1 Oc—C3 halo required odontoidectomy good 14  syringomyelia 5 6, M hemiparesis, headache, Oc—C1 Oc—C4 cervical collar none good 3  neck pain 6

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Harold L. Rekate

canulation). J Neurosurg Sci 30: 47–53, 1986 3. Lapras C , Poirier N , Deruty R , Bret P , Jyeux O : [Catheterization of the sylvian aqueduct. Its present role in the surgical treatment of sylvian aqueduct stenosis of PCF tumors, and of syringomyelia.] Neurochirurgie 21 : 101 – 109 , 1975 (Fr) Lapras C, Poirier N, Deruty R, Bret P, Jyeux O: [Catheterization of the sylvian aqueduct. Its present role in the surgical treatment of sylvian aqueduct stenosis of PCF tumors, and of syringomyelia.] Neurochirurgie 21

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Harold L. Rekate

symptoms the proper approach should be that of “watchful waiting.” Probably the most important piece of information required for surgical decision making is a risk–benefit analysis of the procedure. Symptoms related to the CM-I can be quite subtle and require a careful history and thorough assessment of the physical examination and imaging studies. Sometimes the problems caused by this condition cannot be assessed until after the surgical procedure is done. In the absence of lower cranial nerve deficits or syringomyelia, rapid deterioration and permanent neurological

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Harold L. Rekate, Trimurti Nadkarni and Donna Wallace

malignancy . Invest New Drugs 14 : 69 – 85 , 1996 2 Francis PM , Beals S , Rekate HL , Pittman HW , Manwaring K , Reiff J : Chronic tonsillar herniation and Crouzon’s syndrome . Pediatr Neurosurg 18 : 202 – 206 , 1992 3 Hyde-Rowan MD , Rekate HL , Nulsen FE : Reexpansion of previously collapsed ventricles: the slit ventricle syndrome . J Neurosurg 56 : 536 – 539 , 1982 4 Johnston I , Jacobson E , Besser M : The acquired Chiari malformation and syringomyelia following spinal CSF drainage: a study of incidence and