Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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The aims of this study were to describe the embryological changes that drive the formation of a split spinal cord malformation, analyse the forms of presentation, evaluate the diagnostic procedures and discuss the indications for the different forms of therapy for each case. ⋯ While CT scan is particularly useful for the evaluation of vertebral bodies and posterior arch abnormalities and spur characteristics in SSCM, MRI gives complementary information on the anatomy of spinal cord, dural sac, conus and filum terminale and permits the exclusion of associated lesions such as hydro-syringomyelia, dermal sinus or dermoid and epidermoid cysts. Surgery should be considered indicated in all cases of SSCM, even the asymptomatic ones, except in very badly handicapped meningomyelocele patients with nonprogressive disability and type II SSCM.
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Lumbar intervertebral disc herniation is infrequently encountered in children and adolescents. Additional signs and symptoms such as postural deformities and abnormal gait accompany the classical findings of lumbar root irritation. These unusual signs have been described in the literature as "tight hamstrings syndrome". Waddling gait with flexed knees is considered as pathognomonic for this condition and may be masked by the signs of root irritation due to prolapsed intervertebral disc material. ⋯ We report an adolescent patient with lumbar disc herniation in whom gait abnormality and limitation of lumbar movements persisted after surgical intervention. A review of the literature on tight hamstrings is presented.
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Since the introduction of MRI, the incidence of Chiari I malformations (cerebellar tonsils ectopia) has increased. The clinical significance of this finding remains questionable in some instances. Recently, cine flow MRI has added to the understanding of the dynamics of cerebrospinal fluid at the craniocervical junction and to the pathophysiology of the Chiari I malformation. The present study attempts to analyze the role of cine flow MRI in Chiari I malformations. ⋯ All patients with Chiari I malformation and an associated cervical syrinx had absent cine flow at the craniovertebral junction, and this finding was statistically significant. There was a good correlation between the clinical presentation and cine flow preoperatively, and between clinical improvement and cine flow postoperatively. Patients with Chiari I malformation, cervical syrinx, and absent cine flow preoperatively improved after suboccipital decompression and duroplasty. Patients with Chiari I malformations without syrinx and absent cine flow underwent suboccipital bony decompression alone and had satisfactory outcomes.