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Eldon L. Foltz and David B. Shurtleff

myelomeningocele. Communicating hydrocephalus produced by a basal arachnoiditis, presumably this in turn caused earlier by either a low-grade infection or hemorrhage, 4, 5 predominated as the cause for hydrocephalus. Stenosis of the aqueduct was the second most common site of cerebrospinal-fluid obstruction, and the Walker-Dandy syndrome was the third most common. It was surprising that Arnold-Chiari malformation (Type II) was present in only 3 of 24 patients with myelomeningocele who were operated on and in only 5 of those with myelomeningocele in whom no operation was

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Giuseppe Cinalli, Dominique Renier, Guy Sebag, Christian Sainte-Rose, Eric Arnaud and Alain Pierre-Kahn

abnormalities. The reduced dimensions of the posterior fossa primarily induced by the teratogenic agent would lead to a disproportion between the growing cerebellum and the reduced volume of the posterior fossa, forcing the cerebellum to grow into the only available space in the upper cervical canal. These basic concepts are found in the pathophysiological theory proposed by McLone and Knepper 17 to explain the development of Arnold—Chiari malformation Type II associated with myelomeningocele. These authors proposed that the cerebrospinal fluid leak into the

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Masahiro Shin, Tetsuhiro Nishihara, Shigeo Iai and Tsuneyoshi Eguchi

B , Guthkelch AN : Expansion of central arachnoid pouches. Childs Brain 1 : 364 – 367 , 1975 Williams B, Guthkelch AN: Expansion of central arachnoid pouches. Childs Brain 1: 364–367, 1975 20. Woody RC , Reynolds JD : Association of bilateral internuclear ophthalmoplegia and myelomeningocele with Arnold-Chiari malformation, type II. J Clin Neuroophthalmol 5 : 124 – 126 , 1985 Woody RC, Reynolds JD: Association of bilateral internuclear ophthalmoplegia and myelomeningocele with Arnold-Chiari malformation, type II. J Clin Neuroophthalmol 5: 124

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Jack M. Fletcher, Kim Copeland, Jon A. Frederick, Susan E. Blaser, Larry A. Kramer, Hope Northrup, H. Julia Hannay, Michael E. Brandt, David J. Francis, Grace Villarreal, James M. Drake, John P. Laurent, Irene Townsend, Susan Inwood, Amy Boudousquie and Maureen Dennis

)  vermis 52 (93) 109 (81)  hemispheres * 53 (95) 98 (73)  tonsils 27 (48) 73 (54) Chiari malformationType II 54 (96) 122 (90)  Type I 0 (0) 4 (3) corpus callosum  rostrum   normal 13 (23) 34 (25)   dysgenic 26 (46) 54 (40)   hypoplastic 17 (30) 47 (35)  genu   normal 18 (32) 54 (40)   dysgenic 3 (5) 3 (2)   hypoplastic 35 (63) 78 (58)  body   normal 4 (7) 13 (10)   dysgenic 2 (4) 1 (01

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Farideh Nejat and Syed Shuja Kazmi

Meningoceles are thought to be the products of postneurulation disorder. The neural tube is normally formed beneath the cutaneous lesion; however, when the subsequent development of the overlying mesenchymal tissues and cutaneous ectoderm are aberrant, the result is a cutaneous and mesenchymal defect that contains only cerebrospinal fluid (CSF). Chiari malformation Type II and hydrocephalus are not associated with meningoceles. 1 They are important because of concomitant tethered cord, the chance of CSF leakage, discomfort and pain, their large size, and

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Harold L. Rekate

aqueductoplasty relative to ETV, albeit from a surgeon who performs the procedure from above. In an article on indications for aqueductoplasty, Miki and colleagues 4 found six patients in whom magnetic resonance (MR) imaging studies revealed excessive risks for ETV. Of 110 patients treated endoscopically, only those six patients (5.5%) underwent aqueductoplasty. Clearly patients with a Chiari malformation Type II (spina bifida) are not candidates for the trans—fourth ventricular approach. In these patients the foramen of Magendie lies well below the foramen magnum in the

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Harold L. Rekate

aqueductoplasty relative to ETV, albeit from a surgeon who performs the procedure from above. In an article on indications for aqueductoplasty, Miki and colleagues 4 found six patients in whom magnetic resonance (MR) imaging studies revealed excessive risks for ETV. Of 110 patients treated endoscopically, only those six patients (5.5%) underwent aqueductoplasty. Clearly patients with a Chiari malformation Type II (spina bifida) are not candidates for the trans—fourth ventricular approach. In these patients the foramen of Magendie lies well below the foramen magnum in the

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Mahmoud Hamdy Kamel, Michael Kelleher, Kristian Aquilina, Chris Lim, John Caird and George Kaar

malformation Type II 16 37, M midbrain astrocytoma 17 9 days, M aqueductal stenosis 18 9, M aqueductal stenosis 19 13, M aqueductal stenosis 20 8 mos, M aqueductal stenosis 21 7 mos, M aqueductal stenosis 22 35, F aqueductal stenosis 23 21, F posterior fossa arachnoid cyst 24 52, M aqueductal stenosis 25 73, M normal-pressure hydrocephalus 26 54, M aqueductal stenosis 27 19, M cerebellar astrocytoma 28 54, M normal-pressure hydrocephalus 29

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Francesco T. Mangano, Jose A. Menendez, Tracy Habrock, Prithvi Narayan, Jeffrey R. Leonard, Tae Sung Park and Matthew D. Smyth

exceed the risk of intrinsic valve malfunction (11.1%/year during the first 26 months) in our series. Additional studies performed in a prospective manner with greater numbers of pediatric patients may better reveal the reliability of programmable valve systems, elucidate surgical indications, and lead to overall better outcomes. Disclaimer None of the authors has any financial interest in the devices featured in this study or in the companies that manufacture the devices. Abbreviations used in this paper CM-II = Chiari malformation Type II

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Majid Dadmehr, Farideh Nejat, Saeed Ansari and Zohreh Habibi

examinations were nondiagnostic. Her head circumference was 36 cm, and the fontanelle was wide and bulging. The child otherwise appeared normal. F ig . 1 Photograph showing the ruptured solid mass and the patient’s short, webbed neck. Because emergency magnetic resonance imaging was not available in our hospital, cervical imaging was not performed at the time of admission. Ultrasonography of the brain confirmed ventriculomegaly without Chiari malformation Type II. An ultrasonographic study of the cervical mass was not performed because of the absence of skin and