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Jerry W. Oakes

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Scott Elton and W. Jerry Oakes

Dermal sinus tracts in the spine range from asymptomatic pits to tracts with significant disease. These tracts may be associated with lesions that tether the spinal cord and can either become infected or produce neurological deficits. Over time the treatment of these lesions has varied little: complete resection and intradural exploration are the standard surgical interventions. The authors review their experience with 23 dermal sinus tracts treated in the last 19 years by the senior author. The clinical findings, radiographic appearance, treatment, and pathological findings of these lesions will be discussed. The authors will also provide a summary of the literature covering these lesions.

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W. Jerry Oakes

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Editorial

Venous infarction

W. Jerry Oakes

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Jacob N. Young, W. Jerry Oakes and H. Pall Hatten Jr.

✓ The treatment and subsequent developmental progress of six children with dorsal third ventricular cysts are described. This cystic malformation has a radiological appearance which is superficially similar to that of the dorsal cyst of alobar holoprosencephaly, especially when the third ventricular cyst is large. Indeed, previous reports have identified this abnormality as a form of holoprosencephaly. However, careful study reveals that the dorsal third ventricular cyst is a distinct entity both developmentally and clinically. The six patients in this series were effectively treated with shunts, and their subsequent developmental progress was assessed by means of the Prescreening Developmental Questionnaire-Revised as well as the Bayley Scales of Infant Development. The nomenclature and differences between this entity and the holoprosencephalies are reviewed. The authors conclude that dorsal third ventricular cysts have a developmental and clinical course more similar to that of arachnoid cysts than to that of the holoprosencephalies.

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Joseph H. Piatt Jr., Gerald A. Campbell and W. Jerry Oakes

✓ A 6-month-old child with an isolated oculomotor nerve palsy was found to have a papillary meningioma infiltrating the nerve along its intracranial course adjacent to the midbrain. The clinical implications of this unusual histological variant are discussed.

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R. Shane Tubbs and W. Jerry Oakes

Object. The cisternal portion of the trochlear nerve (fourth cranial nerve) can easily be injured during intracranial surgical operations. To help minimize the chance of such injury by promoting a thorough understanding of the anatomy of this nerve and its relationships to surrounding structures, the authors present this anatomical study.

Methods. In this study, in which 12 cadaveric heads (24 sides) were used, the authors describe exact distances between the trochlear nerve and various surrounding structures. Also described are relatively safe areas in which to manipulate or enter the tentorium, and these are referenced to external landmarks.

Conclusions. This information will prove useful in planning and executing surgical procedures in and around the free edge of the tentorium cerebelli.

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R. Shane Tubbs and W. Jerry Oakes

✓Self-mutilation after deafferentation injuries has rarely been reported in humans. The authors report on a 16-year-old girl who was born with a myelomeningocele. In adolescence it was noted that concurrent with her spinal cord becoming symptomatically tethered she began to self-mutilate her digits. A rare manifestation of the tethered spinal cord may be dysesthesias that led to self-mutilation.

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R. Shane Tubbs and W. Jerry Oakes

✓The authors present the case of a child diagnosed as having Beckwith—Wiedemann syndrome and Chiari I malformation. Hemihypertrophy is associated with Beckwith—Wiedemann syndrome and has been described in conjunction with Chiari I malformation. The authors hypothesize that the hemihypertrophy that may involve the skull base and Chiari I malformation found in their patient are not spurious findings but are pathologically related, perhaps by slight dysmorphologies of the posterior cranial fossa.