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E. S. Gurdjian, J. E. Webster and H. R. Lissner

the freely movable head into motion results in stresses on the structures of the neck that fix the head to the body. These stresses are occasionally so severe as to result in ligamentous and muscular injury, fractures of the cervical spine and spinal cord and brain injury. A discussion of head injury must recognize the occurrence of craniocervical damage. It is quite possible that a patient suffering from a minor head injury may have sustained a major injury to the cervical spine. MECHANISM OF INJURY TO THE SCALP The scalp, which is so commonly involved in

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Richard C. Schneider, Kenneth E. Livingston, A. J. E. Cave and Gilbert Hamilton

reference must be made to the anatomy of this part of the cervical spine, to its intimate relationship with the skull and to the mechanics of the craniocervical junction, based on a study of this region made by one of us (A.J.E.C.) some 30 years ago. The term “cervicocranium” may be applied to the cranium and the vertebrae of the atlas and axis, as the first two cervical vertebrae are profoundly modified structurally that they may act as the handmaids of the superjacent cranium and follow the cranium in the movements of flexion and extension. Thus the vertebra of the

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William M. Chadduck and Martin G. Netsky

-Chiari malformation. Gardner et al. 6 reported an “arachnoid” cyst of the cerebellum causing hydrocephalus by compression of the fourth ventricle. The patient also had basilar impression and other anomalies of the craniocervical junction. The authors believed the cyst was congenital and a manifestation of defective permeability of the roof of the embryonal fourth ventricle. Gardner 5 proposed this same developmental defect as the underlying factor in the pathogenesis of Arnold-Chiari malformation, hydrocephalus, myelomeningocele and other associated anomalies. A subtentorial

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Jorge Weibel, William S. Fields and Robert J. Campos

. Sutton , D., and Trickey , S. E. Subarachnoid haemorrhage and total cerebral angiography. Clin. Radiol. , 1962, 13: 297–303. 24. Walton , J. N. Subarachnoid Haemorrhage . London : E. & S. Livingstone , 1956 , 350 pp. Walton , J. N. Subarachnoid Haemorrhage . London: E. & S. Livingstone, 1956, 350 pp. 25. Weibel , J. , and Fields , W. S. A new technique for craniocervical panarteriography. acta Neurol. latinoam. , 1964 , 10 : 60 – 74 . Weibel , J., and Fields , W. S. A new technique for

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James W. Markham

1 — 1 — Robles, 1968 1 — — 1 Ehrlich, et al. , 1968 1 — — 1 Markham, 1969 1 — — 1 Total 41 23 12 6 Case Report A 50-year-old man was referred because of a bruit of the craniocervical region diagnosed as arteriovenous fistula. The only symptom was a “buzzing” sound in the head, which had been present for 3 months; the patient stated that “it sounded like blood trying to force its way into a vein.” It was unaffected by anything of which he was aware, but was more noticeable at night in

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Sasaki Toshimoto Arai Yasushi Tsukamoto Osamu Sato Keiji Sano April 1973 38 4 506 509 10.3171/jns.1973.38.4.0506 Lymphangioma of the craniocervical junction Harry M. Rogers Shelley N. Chou April 1973 38 4 510 513 10.3171/jns.1973.38.4.0510 Perforation of the anterior annulus during lumbar discectomy William A. Shevlin Alfred J. Luessenhop John L. Fox David C. McCullough April 1973 38 4 514 515 10.3171/jns.1973.38.4.0514 External carotid blood supply to acoustic neurinomas Harvey L

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Harry M. Rogers and Shelley N. Chou

posterior arch of C-1 narrowed the spinal canal at the cervicomedullary junction. Skeletal survey showed multiple lucent cortical defects in the proximal femora and tibias and in the left iliac wing. Pneumoencephalogram was normal, as was the CSF examination. The clinical impression was that he had a dysplastic process in the bone, in and around the craniocervical junction, which was responsible for his headaches. Fig. 1. Skull x-ray film showing multiple lytic lesions in the occiput, base of the skull, and upper cervical spine. Operation On October

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Cervical spine injuries in infants

Problems in management

Lynn M. Gaufin and Stanley J. Goodman

days the tone and strength began to improve in the arms, and the child could grasp objects with either hand. We abandoned our initial plan for internal stabilization with a posterior fusion when a vertebral angiogram revealed that the vertebral arteries were unprotected by bone. This apparent vulnerability of the vertebral arteries, together with the unpredictable pattern of growth that would occur at the craniocervical junction in the presence of a posterior fusion, suggested that we attempt external stabilization. For this purpose, a lightweight Minerva jacket

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Franz E. Glasauer

and the demonstration of various CSF leaks. 1, 3 Isotope myelography has helped diagnose space-occupying lesions that cause spinal fluid block, congenital anomalies of the spine, and occlusive processes at the craniocervical junction. Nerve root avulsion and CSF leakage following lumbar puncture have also been diagnosed and demonstrated by this method. Tandon, et al., 25 emphasized the usefulness of isotope studies in the diagnosis of central nervous system (CNS) tuberculosis and tuberculous meningitis. In addition, isotope cisternography and ventriculography

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Charles J. Hodge Jr. and Robert B. King

craniocervical junction is involved, denervation is more complex. This has been attempted through sectioning multiple sensory cranial nerves and the upper cervical dorsal roots, at times in combination with a trigeminal tractotomy. 34 The results of rhizotomies are frequently poor even though several roots are sectioned rostral and caudal to the area primarily involved in the painful process. 23, 25 The reason for these failures to achieve adequate denervation is unclear, although variations in dermatome, scleratome, and myotome distributions have been suggested. 33 Denny