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Edgar F. Fincher

necessary. In the repair of massive myelomeningocele (rhachischisis) where undermining of the skin into the flank is necessary to gain room for skin closure, gelfoam strips have been resorted to for the obliteration of the mass space remaining. It has been proposed to utilize the gelatin material for filling a counter-incision in the scalp or any other skin surface when such an incision might be necessary to gain a primary wound closure. The rapidity of its absorption in the brain would not suggest that this is a suitable material, but in surface wounds it might serve as

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Arthur Ecker

. , and Davidoff , L. M. The significance of abnormally shaped subarachnoid cisterns as seen in the encephalogram. Correlation with clinical cases. Amer. J. Roentgenol. , 1934 , 32 : 743 – 756 . Dyke , C. G., and Davidoff , L. M. The significance of abnormally shaped subarachnoid cisterns as seen in the encephalogram. Correlation with clinical cases. Amer. J. Roentgenol. , 1934, 32: 743–756. 6. Ecker , A. D. , and Ferguson , J. H. Enormous myelomeningocele with fatal leakage. Malformation at foramen magnum. N

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Jerzy Chorobski and Lucjan Stȩpien

anomalies may be that of a cause to an effect, the spina bifida causing, mechanically, a maldevelopment of the hind-brain. However, it may happen that both anomalies develop independently, at the same time, and due to the same unknown factor. The spina bifida is frequently complicated by a myelomeningocele. Yet, Schwalbe and Gredig 17 emphasized that the malformation of the hind-brain may be encountered also in the presence of a less pronounced form of spinal and meningeal herniation. In fact, Russell and Donald 15 observed a case of malformation of Arnold and Chiari

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Homer S. Swanson and Edgar F. Fincher

evidences of a spina bifida, and the 2nd in a 13-year-old boy who had had a myelomeningocele repaired at birth. Similarly Penfield and Coburn 9 have recorded a case of a 29-year-old woman in whom symptoms due to this anomaly did not appear until 26 years after the repair of a dorsal myelomeningocele. These 2 cases illustrate the latent period of development of symptoms which may follow repair of a spina bifida and support the theory of Russell 10 and others that the Arnold-Chiari malformation may develop in association with a spina bifida. This deformity may occur late

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Duplication of the Spinal Cord (Diplomyelia)

An Account of a Clinical Example with a Consideration of other Reports

Wilfred Pickles

cases of her own. The first patient was a 50-year-old woman with spina bifida occulta and hypertrichosis, without symptoms referable to this condition. At post-mortem examination she was found to have doubling of the cord at the 2nd lumbar segment. The second patient was an 8-month-old girl with subcutaneous myelomeningocele and doubling of the cord. In very beautiful plates, the author shows that there were two complete cords in the lumbar region, rotated at 90° to each other, each with a central canal and a ventral fissure. In this instance, the condition was found

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Samuel P. W. Black and William J. German

roughly 3 per cent of the intraspinal tumors. This figure may be unduly high because the series was compiled relatively shortly after the verification of 3 of the 4 cases. However, in view of the increasing numbers of these tumors that are being reported, they are apparently not as rare as was once supposed. Not included here are a sacrococcygeal teratoma nor two teratomatous cysts which were associated in one instance with a meningocele and in the other with a myelomeningocele. During this same period there have been approximately 525 intracranial tumors verified

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The Surgical Treatment of Arnold-Chiari Malformation in Adults

An Explanation of Its Mechanism and Importance of Encephalography in Diagnosis

W. James Gardner and Robert J. Goodall

published an embryologic and anatomic treatise on the subject in 1907. We have operated upon 17 patients, adults and adolescents, with the Arnold-Chiari malformation and our experience suggests that the fundamental mechanism is obstructive hydrocephalus with resulting foraminal herniation of the hindbrain. Interest in the anomaly was revived in 1935 when Russell and Donald 22 discussed its importance as a possible cause of internal hydrocephalus in spina bifida. They presented 10 examples of myelomeningocele associated with hydrocephalus and Arnold

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Edgar A. Kahn and Lloyd J. Lemmen

defect in the vertebrae which was about 2.5×1 cm. There was no dural sac surrounding this vertebral defect as in the ordinary myelomeningocele. Some fluid appeared in the defect but its origin could not be determined. The entire mass was removed down to what was thought to be epidural space, but the anatomy was poorly defined. The remaining tissue lay free in the vertebral defect. A fascial closure could not be obtained. Muscle flaps and a layer of subcutaneous tissue were sutured over the defect. The skin was closed in a triangular manner, that on the right being

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L. H. Arnstein, Edwin Boldrey and Howard C. Naffziger

5 wks. “Resembles granule cells of cerebellum” ?Medulloblastoma Iter Other anomalies: myelomeningocele, cerebellar aplasia. The varying terminology used by different authors makes comparison of pathological types somewhat difficult, though it would appear that about half of these lesions were gliomas. Contrary to the situation that prevails with the general run of tumors in childhood, 4 most of the tumors in the neonatal period were supratentorial. It will be noted in Table 1 that there were 3 below and 9 above the tentorium, the location

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Edgar A. Bering Jr.

abscess, hydrocephalus of various types, myelomeningocele with Arnold-Chiari malformation, and tuberculous meningitis. The duration of drainage, dictated by the clinical requirements of the patient, was usually 8 days or less (21 patients). However, 2 patients were on drainage for 10 days and 6 patients were on drainage for 15 to 18 days. In 3 patients drainage was complicated by ventriculitis; the most severe case, manifest the day drainage was started, was probably the result of a gross breach of technique in instituting the drainage. The other 2 cases of