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Paul C. Bucy and Ben W. Lichtenstein

the craniovertebral junction resulted in very marked improvement in the clinical picture. REFERENCES 1. Adams , R. D. , Schatzki , R. , and Scoville , W. B. The Arnold-Chiari malformation. Diagnosis, demonstration by intraspinal lipiodol and successful surgical treatment. New Engl. J. Med. , 1941 , 225 : 125 – 131 . Adams , R. D., Schatzki , R., and Scoville , W. B. The Arnold-Chiari malformation. Diagnosis, demonstration by intraspinal lipiodol and successful surgical treatment. New Engl. J. Med. , 1941, 225

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Hydrocephalus

A Contribution Related to Treatment

Olan R. Hyndman

subarachnoid spaces of the sulci (Su.) and was prominent in perivascular spaces (P.S.). MANAGEMENT OF CONGENITAL HYDROCEPHALUS Given an infant with advancing hydrocephalus obvious at birth or shortly thereafter, the chances are so great that the hydrocephalus is not due to a surgical lesion, such as tumor, one may reasonably disregard such a diagnosis. The usual cause will be atresia or absence of the aqueduct of Sylvius, Arnold Chiari malformation or adhesive arachnitis. * One may determine whether the hydrocephalus is communicating or non-communicating by

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Jerzy Chorobski and Lucjan Stȩpien

associated with a meningocele only, and it was clear to them that, in such cases, the deformity of the hind-brain would be of a far less severe order than that seen in cases of myelomeningocele, although it would be of a similar kind. A patient of Penfield and Coburn 14 suffered from the malformation of Arnold and Chiari associated only with an upper thoracic meningocele. No evidence of spina bifida was seen in the case of Aring 2 or in Case I of Adams, Schatzki and Scoville. 1 Penfield and Coburn, 14 reporting their observation of an Arnold-Chiari malformation in an

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Homer S. Swanson and Edgar F. Fincher

case that we set forth our experiences in dealing with this problem of the Arnold-Chiari malformation without demonstrable bony anomaly. CASE REPORT History . A 5-year-old white female was seen in consultation on April 28, 1947. She was the first born of the family. Her birth and developmental history were entirely normal, and she had had none of the usual childhood diseases. In November 1946, the mother first became aware of the fact that the child was less active than usual, that she appeared listless and preferred not to run and play as she had formerly. She

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Samuel P. W. Black and William J. German

. Ingraham , F. D., and Bailey , O. T. Cystic teratomas and teratoid tumors of the central nervous system in infancy and childhood. J. Neurosurg. , 1946, 3: 511–532. 19. Ingraham , F. D. , and Scott , H. W. , Jr. Spina bifida and cranium bifidum. V. The Arnold-Chiari malformation: a study of 20 cases. New Engl. J. Med. , 1943 , 229 : 108 – 114 . Ingraham , F. D., and Scott , H. W., Jr. Spina bifida and cranium bifidum. V. The Arnold-Chiari malformation: a study of 20 cases. New Engl. J. Med. , 1943, 229: 108

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Everett F. Hurteau

It has repeatedly been mentioned that Arnold-Chiari malformation without abnormality of the cervical spine is unusual, 1, 2 and the difficulties in diagnosing the lesion under such circumstances have been indicated. The following case is thus presented for its statistical value and may contribute something of diagnostic and therapeutic value as well. CASE REPORT A 23-year-old white female was admitted to the hospital on Feb. 22, 1948 complaining of headache which began about 1 year previously. This symptom had been progressive and accompanied by vomiting

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The Problem of the Glioblastomas Ernest Sachs May 1950 7 3 185 189 10.3171/jns.1950.7.3.0185 Epidermoids: Clinical Evaluation and Surgical Results Francis C. Grant George M. Austin May 1950 7 3 190 198 10.3171/jns.1950.7.3.0190 The Surgical Treatment of Arnold-Chiari Malformation in Adults W. James Gardner Robert J. Goodall May 1950 7 3 199 206 10.3171/jns.1950.7.3.0199 The Electroencephalogram in Subdural Hematoma George W. Smith William H. Mosberg E. T. Pfeil R. H. Oster May 1950 7 3

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The Surgical Treatment of Arnold-Chiari Malformation in Adults

An Explanation of Its Mechanism and Importance of Encephalography in Diagnosis

W. James Gardner and Robert J. Goodall

T he Arnold-Chiari malformation is a deformity of the hindbrain in which a tongue-like projection of the cerebellar tonsils protrudes through the foramen magnum down onto the cervical cord. The caudad portion of the 4th ventricle likewise is elongated downward. The upper cervical nerve roots pursue a cephalad direction, giving the impression that the brain stem has been drawn down through the foramen magnum. The malformation was named after Arnold 3 and Chiari 6 who independently described the anomaly in 1894 and 1895 respectively. Schwalbe and Gredig 23

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Edgar A. Bering Jr.

abscess, hydrocephalus of various types, myelomeningocele with Arnold-Chiari malformation, and tuberculous meningitis. The duration of drainage, dictated by the clinical requirements of the patient, was usually 8 days or less (21 patients). However, 2 patients were on drainage for 10 days and 6 patients were on drainage for 15 to 18 days. In 3 patients drainage was complicated by ventriculitis; the most severe case, manifest the day drainage was started, was probably the result of a gross breach of technique in instituting the drainage. The other 2 cases of

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William A. Nosik

Not infrequently, the protrusion of the dura and arachnoid through a defect in either the vertebral arch or the cranium is encountered. Where no notable inclusion of neural elements exists, and no Arnold-Chiari malformation can be demonstrated, local surgical correction may be undertaken. The operative procedures usually consist of resection of the sac or its inversion into the canal, with an approximation of the edges of the dehiscence. Where the defect is large, it may not be possible to effect a satisfactory primary closure, unless the sutures are placed