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M. Hunter Brown and Lester D. Powell

placed intact neural arch. Other adjuncts to the surgical management are closure without drainage, obliteration of the dead space by soft part suture or postoperative elastic pressure, and the employment of prophylactic chemotherapy. The abdominal and the transvaginal routes of approach to expose an anterior meningocele have proven almost uniformly unsuccessful and often fatal. The technique of posterior drainage and packing of a dead space that leads to the spinal theca and opens immediately contiguous to the anus invites disaster in the form of retrograde

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Pelvic Meningocele

A Case Report

R. Bruce Henley and Lester B. Lawrence

pathognomonic. In 1938, Adson 1 described the posterior approach for the surgical treatment of the anterior meningoceles. In spite of his warning and the comments of subsequent authors, including Coller and Jackson 2 in 1943 and of Jones and Evans 4 in 1959, serious complications have arisen from the mishandling of this condition. The treatment of choice is simply that of ligation and removal of the fistula through the posterior approach leaving the sac in place in the pelvis after the fluid has been aspirated. Laparotomy should not be performed. A correct diagnosis of

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William I. Silvernail Jr. and Richard B. Brown

hemivertebrae. The interpedicular distance was markedly widened. A cervical myelogram ( Fig. 1 ) showed nearly complete obstruction, with only a minimal amount of contrast medium passing through the gutters, and marked distension and dilatation of the central portion of the cord suggestive of an expanding intramedullary process. The lateral view showed a small but smooth outpocketing at the region of C6–7 suggestive of a small anterior meningocele. The spinal fluid protein concentration was 22 mg%. Fig. 1. Cervical myelograms showing marked widening of the

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James E. McLennan, William T. McLaughlin and Stanley A. Skillicorn

foot & posterior thigh  root seen Alker, et al. 19 M separation both comminuted, open flaccid paralysis anterior meningocele rt L5-S2, none yes diffuse atrophy & paralysis below knee, weak  (1967)  SIJ's, fracture  fracture lt femur  compartment rt leg, absent  no L5-S2 roots seen  thigh abductors, hip extensors, & knee  pubic symphysis  AJ & KJ, total sensory loss  flexors, trophic skin changes (4 mos)  & lower 3  L4-S4  sacral foramina

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Extraspinal ependymomas

Report of three cases

Robert A. Morantz, John J. Kepes, Solomon Batnitzky and Byron J. Masterson

divided such masses into five main categories: 1) inflammatory, 2) congenital, 3) neurogenic, 4) osseous, and 5) miscellaneous. The inflammatory lesions include perirectal abscesses and internal fistulas. The congenital tumors occurring in this location are the chordomas, teratomas, and dermoids. In addition to the ependymomas reported here, the other neurogenic tumor arising in this location is the neurofibroma. The osseous tumors include osteogenic sarcoma, cartilagenous tumors, and giant-cell tumors of the bone. Miscellaneous lesions include anterior meningoceles and

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Peter Dyck and Charles B. Wilson

migration of the proximal cut end of the filum terminale. The residual communication into the anterior meningocele was closed by oversewing a piece of muscle. Immediately postoperatively, the groin mass and pain disappeared and examination revealed no neurological dysfunction. On the 7th day postoperatively, a pelvic sonogram demonstrated a small residual fluid-filled cystic mass measuring approximately 5 cm in its maximum dimension. At her 6-week postoperative evaluation, the patient was still asymptomatic, and pelvic ultrasound demonstrated the mass to measure only 3 cm

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Matthew R. Quigley, Frank Schinco and J.Thomas Brown

✓ A case of familial anterior sacral meningocele associated with a dermoid tumor is reported. This patient presented with recurrent aseptic meningitis. The role of computerized tomography following metrizamide myelography in the diagnosis of this lesion is discussed.

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W. Eugene Stern

. Fifty-one adults, all with Marfan's syndrome, were examined; two of these had radicular pain, and one had weakness in an L5–S1 distribution. Of the 51 adults, 65% (13 females and 20 males) showed some degree of dural ectasia in the lower lumbar and sacral canals. In 11 of these patients, the ectasia was judged to be severe based upon the presence of anterior meningoceles or near-total dissolution of the pedicles. It was interesting that the authors found that the patients with the most severe vertebral changes tended to have high severity scores based upon a survey of

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Richard E. Clatterbuck, Stephen V. Jackman, Louis R. Kavoussi and Donlin M. Long

were obliterated. Intradural exploration revealed a patent hole on the right side containing an exiting S-1 nerve root. The connection between the cyst and the right S-1 foramen was packed with a fat graft; however, it was not possible to obliterate the anterior meningocele via this posterior approach. The patient's radicular symptoms recurred, and, in a separate procedure 9 months later, she underwent laparoscopic exploration ( Fig. 2 upper ). The cyst was opened in a cruciate fashion and its edges cauterized. Its communication with the spinal subarachnoid space

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Peter P. Sun, Glen J. Poffenbarger, Susan Durham and Robert A. Zimmerman

tectorial membrane normally appears as a superior extension of the posterior longitudinal ligament in close approximation to the apical dens that comes in contact with the clivus. 48 Grabb and colleagues 20 have reported three cases of tectorial membrane disruption in children. Naso and associates 40 have reported two cases of atlantooccipital dislocation with anterior meningocele and apparent disruption of the tectorial membrane. In the present study, loss of continuity of the tectorial membrane was found in only one case in which the atlantooccipital dislocation was