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Raheel Ahmed and Arnold H. Menezes

disorders affecting the CVJ. 15 Neurological manifestations of this congenital disorder arise as a consequence of bony compression of the craniocervical junction. We describe a rare clinical presentation in a patient with an underlying proatlas segment bony abnormality who presented with a palatal tremor. Palatal tremor is a rare movement disorder that consists of involuntary rhythmic muscular contractions of the palatal musculature. 21 In contrast to other treatments for the common causes of palatal tremor, surgical decompression of the underlying craniovertebral

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Marcílio Diogo de Oliveira Barbosa, Thiago de Bellis, Marcelo Sampaio Pousa, Rodrigo Sodré Calheiros da Silva, Flávio Assad Garcia and Marcus André Acioly

while in the spine, they predominantly affect the thoracic segment. 4 We report on the unique case of a bullet retained in the cerebellomedullary cistern, discussing the treatment strategy that we have adopted since this situation, to the best of our knowledge, has never been presented to date. Case Report History and Examination A 6-year-old girl was admitted to our emergency room with a GSW in the posterior craniocervical junction. On admission, she was alert (Glasgow Coma Scale Score 15) with reactive pupils. Incomplete tetraparesia (left flaccid

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Smruti K. Patel and James K. Liu

junction posterolat approach Fujita et al., 1997 16 yrs † M clivus/CPA retromastoid suboccipital craniectomy Lonjon et al., 1998 14 yrs M foramen magnum suboccipital craniectomy w/ C1–2 laminectomy Ergün et al., 2000 3 yrs M craniocervical junction posterior laminoplasty Vlaho et al., 2003 2 yrs M 3rd ventricle neuroendoscopic fenestration of 3rd ventricle cyst Goel et al., 2005 10 yrs F anterior & anterolat to brainstem retrosigmoid approach 18 yrs M anterior & anterolat to brainstem retrosigmoid

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Merdas Al-Otibi, Andrew Jea and Abhaya V. Kulkarni

occipital plexus then out through the extracranial vertebral veins via transcranial anastomoses. F ig . 2. Sagittal (A), coronal (B) and axial (C) CT venograms demonstrating the presence of abnormally dilated extracranial venous collaterals, comprising vertebral and paravertebral plexuses, at the level of the craniocervical junction, making posterior fossa decompression dangerous. Arrows mark the paramedian venous anomalies of concern. Evaluation Based on this worrisome venous collateral anatomy, the option of posterior fossa decompression was abandoned

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Yukio Takamura, Tsuyoshi Kawasaki, Akira Takahashi, Katsuyuki Nunomura, Kei Tiba, Masahiro Hasunuma and Takeo Itou

. Discussion We treated a patient with acquired tonsillar herniation, in whom serial MR images apparently demonstrated patent and isolated segments of the central canal visible in the midcervical segments preferentially participating in the dilatory process, which was acutely transformed into a syrinx. In this case the acquired tonsillar herniation was caused by hydrocephalus and adhesive arachnoiditis around the foramen magnum induced by craniocervical junction injury. Surgical decompression of the craniocervical junction and lysis of arachnoid adhesions around foramen

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Michelle J. Clarke, Patricia L. Zadnik, Mari L. Groves, Daniel M. Sciubba, Timothy F. Witham, Ali Bydon, Ziya L. Gokaslan and Jean-Paul Wolinsky

T he biomechanical structures of the craniocervical junction and subaxial spine transmit load-bearing forces from the skull to the torso while allowing head movement and protecting vital structures. 31 At the craniocervical junction, axial forces are transmitted from the occipital condyles to the lateral masses of C-1 to the lateral masses of C-2. This is the only portion of the spinal axis in which a central vertebral body does not provide the majority of support. 32 Below C-2, the vertebral body bears the majority of the static axial load, while the

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Charles Kulwin, Bradley N. Bohnstedt, John A. Scott and Aaron Cohen-Gadol

. 13 In this paper we present 2 patients with brainstem dysfunction secondary to DAVF. One harbored a Cognard V DAVF and the other a cervical DAVF. We review the literature for similar rare aggressive DAVFs at the craniocervical junction presenting with brainstem symptomatology. Case Reports Case 1 This 44-year-old woman presented with acute onset of altered mental status, right hemiparesis, and limb dyscoordination. Subsequently, she became hypopneic when asleep and was transferred to a nursing home after undergoing a tracheostomy for central

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Alex Alfieri and Giampietro Pinna

and issues such as craniectomy size, whether the arachnoid should be opened, the size of an artificial cisterna magna, and cerebellar tonsil coagulation remain controversial matters. 7 , 9 , 12 , 14 , 21 , 25 , 39 , 48 The goal of the present study was to report the long-term results from a consecutive series of adult patients with CM-I–related syringomyelia who underwent, at a single institution, standardized decompressive surgery of the craniocervical junction with arachnoid exploration and cerebellar tonsil reduction. Methods Patient Population All

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Dominic N. P. Thompson, Richard D. Hayward, William J. Harkness, Robert M. Bingham and Barry M. Jones

fusion of the bodies and posterior elements of C4–6. Atlantoaxial subluxation is also shown. Magnetic resonance (MR) imaging of the head and craniocervical junction confirmed the extent of the turricephaly and considerable anteroposterior shortening of the skull base ( Fig. 3 ). The anterior cranial fossa was foreshortened, the clivus steeply inclined, and the posterior fossa small. The brainstem appeared elongated and the medulla kinked. There was also striking herniation of the hindbrain with the cerebellar tonsils extending to the level of the axis vertebra

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describe three patients in whom high-field intraoperative magnetic resonance (MR) images were acquired at various stages during the transoral resection of C-2 disease that had caused craniocervical junction compression. All three patients harbored different lesions involving the cervicomedullary junction: one each of plasmacytoma and metastatic breast carcinoma involving the odontoid process and C-2 vertebral body, and basilar invagination with a Chiari I malformation. All patients presented with progressive myelopathy. Surgical planning MR imaging studies performed