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R. Shane Tubbs and W. Jerry Oakes

patient with hypophosphatemic rickets and Chiari I malformation and hypothesize that overgrowth of the posterior fossa necessitated egress of the cerebellar tonsils from within the posterior fossa and into the cervical subarachnoid space. We have shown that the posterior fossa volume is significantly less in patients with rickets and those with rickets with Chiari I malformation. 30 Are slight hypertrophies of the cranium present in patients with overgrowth syndromes, as in our patient with BWS without facial involvement? Could slight overgrowth of the posterior fossa

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R. Shane Tubbs and W. Jerry Oakes

Object The authors sought to establish whether the volume of the posterior fossa in children suffering from Chiari malformation Type I (CM-I) is smaller than normal, as has been suggested previously. They also investigated the role of syringomyelia in posterior fossa development. Methods Both posterior fossa volume (PFV) and intracranial volume (ICV) were measured using segmentation techniques on preoperative magnetic resonance images obtained in 42 children who underwent surgery for CM-I (mean age 127 months, range 36–204 months); 25 (59%) of the

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Christopher J. Wahl, R. Shane Tubbs, Dennis D. Spencer and Aaron A. Cohen-Gadol

Yale University and is one of the finest in the world. Cushing stated: “. . . there is only one thing to do with a young man: place both books and cigarettes in his way and caution him to beware of them as dangerous habits. He'll certainly take to one, and perhaps both. . .This may after all be the right tack—to warn young people against books. Or at least against book collecting; for one may easily become enslaved and soon so enveloped by books that they are on the floor and out in the front hall and in the dining room till you never can find the volume you want

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R. Shane Tubbs, Daniel B. Webb and W. Jerry Oakes

T he exact mechanism of syrinx formation in the presence of hindbrain herniation is unknown; however, techniques aimed at removing tissue from the region of the midline fourth ventricle outlet, such as decompressive procedures, are used in the treatment of this clinical entity. Some authors have discussed the use of suboccipital craniectomy with and without duraplasty, 14 tonsillar coagulation only, 13 and direct shunting of the fluid cavity. 8 Duraplasty in cases of concomitant syringomyelia may lead to a more reliable reduction in the volume of the syrinx

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R. Shane Tubbs, Matthew J. McGirt and W. Jerry Oakes

pressure gradient favors tonsillar herniation and may be responsible for the initiation of syringomyelia formation. 56–60 The aforementioned data support the response seen in the current treatment of a Chiari I malformation, that is, posterior fossa decompression. Regarding a cause of the Chiari I malformation, Schady, et al., 44 found that the volume of the posterior fossa was 23% smaller in patients with the malformation when compared with that in control patients. Other anomalies that further restrict the movement of the posterior fossa contents, such as occipital

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R. Shane Tubbs, Mark Hill, Marios Loukas, Mohammadali M. Shoja and W. Jerry Oakes

C hiari malformation Type I has been defined as a herniation of the cerebellar tonsils at least 3–5 mm caudal to the foramen magnum. 10 , 21 While the actual herniation may occur under a variety of precipitating circumstances (for example, hydrocephalus, intracranial mass), decreased volume of the posterior cranial fossa is thought to be one predisposing factor in some cases. 1 , 2 , 5 , 10 , 12 , 15 Several studies have attributed this insufficient posterior fossa geometry to embryological defects in paraaxial mesoderm. 9 , 10 Given the developmental

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R. Shane Tubbs, Elizabeth C. Tyler-Kabara, John C. Wellons III, Jeffrey P. Blount and W. Jerry Oakes

menstrual cycles. 5 Excessive production is observed in association with certain disease processes; for example, it is known that intrahepatic portal hypertension can produce large quantities of peritoneal fluid. On the other hand, some normal processes, such as pregnancy, also increase the quantity of this fluid. 1 The most recent theory for excessive peritoneal fluid production is that portal hypertension leads to vasodilation, which causes decreased effective arterial blood volume. 1 As the natural history of the disease progresses, neurohumoral excitation increases

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Asem Salma, Julian Lin and Daniel R. Fassett

Anatomic Basis for Clinical Neuroscience Philadelphia , Elsevier Saunders , 2011 . 84 4 Packer RJ , DeBraganca KC , Kadom N , Presentation and clinical features of medulloblastoma . Mehta MP , Chang SM , Guha A , : Principles & Practice of Neuro-Oncology: A Multidisciplinary Approach New York , Demos Medical Publishing , 2010 . 267 – 271 5 Paulino AC , Extraneural metastasis in medulloblastoma . Hayat A : Tumors of the Central Nervous System. Volume 8: Astrocytoma, Medulloblastoma, Retinoblastoma, Chordoma, Craniopharyngioma

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R. Shane Tubbs, Payman Vahedi, Marios Loukas, Mohammadali M. Shoja and Aaron A. Cohen-Gadol

Luschka gland lymph node found btwn the common hepatic & cystic ducts Luschka joints uncovertebral joints Luschka muscle levator ani, papillary muscle of the conus, and potential muscle fibers w/in the uterosacral ligament Teaching and Anatomical Research Luschka's lively lectures made him a favorite among his students, and his 3-volume textbook of clinical anatomy, published between 1862 and 1867, was considered the gold standard for medical students of his day. His work focused on the aspects of anatomy pertinent to medicine and surgery, and he

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

malformation. In many of these patients a smaller than normal posterior fossa volume has been noted. 16, 22, 23 We could not analyze the posterior fossa volume in this retrospective study, but did find that the basiocciput was not statistically shorter in the midsagittal plane compared with controls for each age (p > 0.05). There were no statistical differences between grades of odontoid angulation and the length of the basiocciput. Lang12 has shown that the midsagittal distance of the basiocciput has a mean range of 13.1 to 19.1 mm in children age 0 to 6 years. Our mean