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Biji Bahuleyan, Girish Menon, Easwer Hariharan V, Mridul Sharma and Suresh Nair

the SDH. On opening the dura mater, clear fluid drained under high pressure. Postoperative Course The patient's condition gradually improved, and he was asymptomatic at the 8-month follow-up. Discussion Foramen magnum decompression is the most widely used surgery for the treatment of CM-I. 3 , 5 , 6 Many surgeons prefer not to open the dura, some prefer to do a lax duraplasty leaving the arachnoid intact, and still others prefer to perform arachnoidolysis along with duraplasty. Keeping the arachnoid intact prevents blood from entering the subarachnoid

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Atul Goel and Abhidha Shah

neuralgia. 3 , 7 We evaluated the relevant literature on the subject and the possible treatment strategy in such cases. The applied treatment for the trigeminal neuralgia in our case was foramen magnum decompression. Such a therapeutic modality for trigeminal neuralgia has not been reported in the literature. Case Report History and Examination This 65-year-old woman, who was otherwise healthy and had no systemic illness, presented with symptoms of trigeminal neuralgia, which she had experienced for a period of 7 years. She had had a short neck since birth. A

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Arthur R. Kurzbuch and Shailendra Magdum

showed a Chiari I malformation with the cerebellar tonsils descending to C2 but without a syrinx ( Fig. 1 ). The MRI did not show signs of hydrocephalus. The patient’s neurological status was normal. Foramen magnum decompression with a limited suboccipital craniectomy of 2.5 × 1.5 cm and partial resection of the posterior arch of C1 was performed, followed by a wide durotomy and opening of the arachnoid. While the dura was left open, meticulous closure of the muscles, fascia, subcutaneous tissue, and skin was done. Three years later, when the patient was 7 years old

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Jörg Klekamp

, what kind of material should be used for grafting? This study was undertaken to analyze patients with CM-I who presented with new neurological symptoms after foramen magnum decompression. Had the decompression failed, and for what reason? Or was there evidence for another pathology unrelated to the CM? For patients requiring a foramen magnum revision, the analysis of intraoperative findings and the postoperative course may provide useful information for treatment of this condition in general. This paper suggests an algorithm for how to proceed in a patient with new

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Neurosurgical Forum: Letters to the Editor To The Editor Jacqueline T. Hecht , Ph.D. Ian J. Butler , M.D. William A. Horton , M.D. University of Texas Medical School Houston, Texas 300 301 We found the article by Moskowitz, et al. , to be interesting (Moskowitz N, Carson B, Kopits S, et al: Foramen magnum decompression in an infant with homozygous achondroplasia. Case report. J Neurosurg 70: 126–128, January, 1989). However, the efficacy of this procedure remains in doubt

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Neurosurgical Forum: Letters to the Editor To The Editor R. Michael Scott , M.D. The Children's Hospital, Boston, Massachusetts 519 519 I wish to congratulate Moskowitz, et al. , for their superb operative management of the homozygous achondroplastic infant with a small foramen magnum and ventilator dependence (Moskowitz N, Carson B, Kopits S, et al: Foramen magnum decompression in an infant with homozygous achondroplasia. Case report. J Neurosurg 70: 126–128, January, 1989). It is not correct for them to

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Atul Goel

TO THE EDITOR: We read with interest the article by Kennedy et al. 8 (Kennedy BC, Kelly KM, Phan MQ, et al: Outcomes after suboccipital decompression without dural opening in children with Chiari malformation Type I. J Neurosurg Pediatr 16:150–158, August 2015). The authors discuss a relatively large series of patients with Chiari malformation Type I (CM-I) who were treated by foramen magnum decompression without resorting to opening of the dura mater. The authors report a positive outcome of symptoms following such a strategy of treatment. They discuss

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Nathan Moskowitz, Benjamin Carson, Steven Kopits, Roy Levitt and Graeme Hart

survive 29 to 37 months due to the implementation of an aggressive respiratory management system and in one case due to foramen magnum decompression. This report offers insights into the surgical management of the rare clinical entity of homozygous achondroplasia and suggests the potential viability of these infants. Based on our experience, aggressive respiratory and surgical measures are indicated in infants with homozygous achondroplasia. Case Report This 2.145-kg homozygous achondroplastic baby boy (AA) was referred at 16 weeks of age. His parents were both

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Alexis J. Joannides, Thomas Santarius, Helen M. Fernandes, Rodney J. C. Laing and Rikin A. Trivedi

L ocal anesthesia is used widely, in isolation or in conjunction with general anesthesia. Associated complications, although rare, include seizures and cardiac arrhythmias. We describe 2 cases of brainstem paralysis following the administration of a levobupivacaine field block after foramen magnum decompression for Chiari Type I malformation. Case Reports Case 1 This 15-year-old, 51-kg girl underwent elective FMD for symptomatic Chiari Type I malformation. Apart from mild asthma, she did not have any comorbidities, did not take any regular

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Atsushi Ono, Futoshi Suetsuna, Kazumasa Ueyama, Toru Yokoyama, Shuichi Aburakawa, Kazunari Takeuchi, Takuya Numasawa, Kanichiro Wada and Satoshi Toh

lordosis. A minimally invasive surgical approach was chosen, in which only the outer layer of the dura mater was incised, thus avoiding complications such as postoperative leakage of the cerebrospinal fluid and surgery-related adhesive arachnoiditis. 17 , 22 The results of our study indicated that the surgical technique had no effect on the postoperative cervical ROM. Foramen magnum decompression is considered to be an effective surgical technique for CM-I occurring with syringomyelia. Conclusions We evaluated the relationship between the preoperative cervical ROM