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M. Hunter Brown and Lester D. Powell

Anterior sacral meningocele is a meningeal cyst which presents anteriorly through a unilateral congenital defect in the sacrum, in contrast to the usual posteriorly situated midline meningocele. In recent years the condition has aroused increasing interest due to its rarity and to the unhappy complications resulting from incorrect diagnosis and treatment. In their extensive review of the literature Coller and Jackson 1 , uncovered 23 cases, of which 18 were treated surgically with a case mortality rate of 44 per cent, and eight patients of this group were

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Robert W. Long and Nikolai Rachmaninoff

syringomyelia. An atypical myelogram was produced by injection of contrast medium into the cyst lumen. At autopsy it was found that the meningeal cyst had partially invaginated into the substance of the spinal cord, but did not communicate with the central canal. References 1. Elkington , J. St. C. Meningitis serosa circumscripta spinalis (spinal arachnoiditis). Brain , 1936 , 59 : 181 – 203 . Elkington , J. St. C. Meningitis serosa circumscripta spinalis (spinal arachnoiditis). Brain , 1936, 59: 181–203. 2. Elsberg

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Frank Goldstein, Thomas Sakoda, John J. Kepes, Kendrick Davidson and Charles E. Brackett

1954, Penfield and Jasper noted cranial defects produced by arachnoidal granulations and large dural defects. However, they did not know whether “the cerebral hemisphere from which leptomeninges had been removed,” would cause craniocerebral erosion. 7 In 1961, Lende felt there were more factors involved in the production of meningeal cysts than “an unsuspected dural tear,” for in his fifth case the “loss of the dura mater was greater in extent than the loss of bone,” indicating a deficiency of the dura mater greater than a simple tear occurring at the time of

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Gajendra Sinh, S. K. Pandya and Darab K. Dastur

cyst. While clear giant cell systems were not encountered, the predominant plasma cell reaction with vasculitis in a fibrovascular matrix throughout the cyst wall pointed to its granulomatous nature. The intracerebral tuberculoma subjacent to the anterior portion of the cyst also supports this conclusion. We think that this was not a meningeal cyst with secondary infection but rather the formation of a cyst in thickened tuberculous leptomeninges. Its extensiveness, almost covering the whole hemisphere, would lend support to this view. The Development of a

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Sheldon A. E. Rosenthal, J. Grieshop, Larry M. Freeman and Frank P. Goldstein

G rowing fractures of childhood have been described in humans and simulated in an experimental model using puppies. 3 Clinically, these uncommon growing fractures are seen only in infants and children. A thorough review of the world's literature and discussion of clinical features of this syndrome were presented in 1961 by Lende and Erickson. 4 Other cases subsequently have been reported. Meningeal cysts are frequently found at the enlarging fracture site and have even been implicated etiologically. 5 The following investigation was designed to determine

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B. Ramamurthi and S. Kalyanaraman

when the pneumoencephalogram showed only an enlarged ventricle on the affected side, thus indicating lack of pressure on the cortex. Hence to blame pressure from a meningeal cyst for the epilepsy does not seem justified. Epilepsy and hemiparesis in these cases could arise only from direct cortical injury, and the methods of surgery so far advocated do not deal with this problem directly. If hemiparesis cannot be improved and if the fits can be controlled by drugs, then the indication for surgical therapy becomes limited only to the cranial defect. Our experience

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Chun C. Kao, Stefan S. Winkler and J. H. Turner

: Posttraumatic lumbar extradural true synovial cyst: case report. J Neurosurg 39 : 246 – 248 , 1973 Sypert GW, Leech RW, Harris AB: Posttraumatic lumbar extradural true synovial cyst: case report. J Neurosurg 39: 246–248, 1973 5. Tarlov IM : Spinal perineural and meningeal cysts. J Neurol Neurosurg Psychiat 33 : 833 – 843 , 1970 Tarlov IM: Spinal perineural and meningeal cysts. J Neurol Neurosurg Psychiat 33: 833–843, 1970

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Hilel Nathan and Samuel Rosner

cysts of the meninges. 16, 17, 21, 23, 24 However, the dilatations of the meninges we found in this anatomical specimen fit exactly, according to Tarlov's descriptions, 22 the diagnosis of meningeal diverticula and meningeal cysts. They were all located proximal to the ganglia, and communicated freely with the subarachnoid space. Unfortunately, we could not obtain clinical information about the case. Beside the great variation in number, location, and size of the diverticula, perhaps the most interesting anatomical characteristic of the specimen is the duplication

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Randolph George, Lyal Leibrock and Mel Epstein

.0  Arnold-Chiari malformation 8 47 17.0 3 17 17.6 11 64 17.2  others (cavum septum pellucidum, agenesis of corpus callosum, meningeal cyst, anencephaly, schizencephaly) 4 45  8.9 4 45 8.9  total 60 388 15.5 26 130 20.0 86 518 16.6 Communicating - Trauma and Hemorrhage  previous tumor surgery 1 10 10.0 4 20 20.0 5 30 16.7  previous trauma 3 30 10.0 0 6  0 3 36 8.3  previous subarachnoid or intraventricular hemorrhage 1 17 5

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Hideaki Masuzawa, Hitoshi Nakayama, Nobuyuki Shitara and Takeyo Suzuki

laminectomy or penetrating injury to the dura mater. It may reasonably be postulated that our patient suffered herniation and incarceration of the spinal cord in a previously empty congenital extradural arachnoid cyst. This is further substantiated by the concomitant presence in our patient of various meningeal cysts and diverticula of congenital origin. 14 Congenital extradural arachnoid cysts 5, 6, 8, 14 are rare conditions and usually occur in the midthoracic area. Etiology of these cysts was proposed 5 as either a congenital diverticulum of the dura mater or