Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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The incidence of tumors at the craniovertebral junction in the pediatric population is low. Because of the variable pathology and the rarity of these tumors, ideal therapies are only now being defined. ⋯ Chordomas of the clivus and foramen magnum were seen in eight, fibrous dysplasia in four, aneurysmal bone cysts in four, eosinophilic granuloma affecting the atlas and axis vertebra in four, Ewing's sarcoma involving the atlas in two, osteoblastoma in two, neurenteric cysts in four, meningioma in five, schwannoma in two, and plexiform neurofibromas in three. The location of these tumors was predominantly ventral, and a very small number had a lateral or dorsal location. The ventral tumors included chordoma, meningioma, fibrous dysplasia, aneurysmal bone cyst, and osteoblastoma. Plexiform neurofibroma affecting the craniocervical junction was ventral to the clivus and upper cervical spine causing severe kyphosis of the craniocervical region. Pain in the head and neck occurred in 70%. Paresthesias and dysesthesias in the hands were seen in 40% and spastic weakness of extremities in 22%. Cranial nerve palsies were seen in 33%. Twenty-eight percent of children showed dysphagia or dysarthria. The cranial nerves affected were the vagus followed by hypoglossal and glossopharyngeal nerves. This led to dysphagia, slurred speech, repeated aspiration pneumonia, and weight loss. The most common findings for chordomas at the craniocervical junction were isolated hypoglossal nerve palsy. All individuals underwent magnetic resonance imaging, computed tomography, and 3D computed tomography and angiography. Vertebral angiography was used to understand the dynamics of collateral circulation and tumor vascularity. Tumor embolization was performed in chordoma and aneurysmal bone cysts. Our experience and results are presented here.
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Lesions that affect the lower clivus, foramen magnum, the craniocervical junction, and the upper cervical spinal canal that are anterolateral and at times intradural require access ventral to the cerebellum and spinal cord. The posterolateral transcondylar approach provides such a route. In addition, posterior craniocervical stabilization can be accomplished at the same time. The author has reviewed the technique as well as the surgical results here. ⋯ The posterolateral transcondylar route is a versatile avenue to approach a variety of lesions ventrolateral to the brain stem and upper cervical cord. Exposure is quite satisfactory with minimal or no retraction of important neurovascular structures in the region. Modifications of this theme can be applied as the lesions require.
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Previous anatomic studies have shown the conus medullaris to terminate between T12 and L1 vertebral levels in adults with normal spinal anatomy. Prior anatomic and radiographic studies of conus position with flexion and extension of the spine have had conflicting results. We performed a cadaveric study with direct visualization of the conus during flexion and extension to further study this question and potentially determine if flexion and extension of the spine during magnetic resonance imaging may prove to be a diagnostic tool in such pathologies as occult tethered cord syndrome. ⋯ Flexion of the spine does not cause the conus medullaris to change position in fresh human cadavers; however, flexion does cause the cauda equina to stretch and displace medially over the conus. Therefore, it is unlikely that the conus would change position during spine flexion during imaging or procedures such as lumbar puncture.
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Arachnoid cysts constitute 1% of all intracranial mass lesions not resulting from trauma. Suprasellar arachnoid cysts (SACs) are uncommon. Obstructive hydrocephalus is the most common cause of initial symptoms and occurs in almost 90% of the patients with suprasellar arachnoid cyst. We report on 17 patients with suprasellar arachnoid cyst who were treated with neuroendoscopic intervention. ⋯ Endoscopic surgery should be the first choice in the management of SACs. Neuroendoscopic VCC is successful in the majority of the cases.
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The aims of this study were to describe and analyze the technique of neuroendoscopic foraminal plasty of foramen of Monro (NEFPFMO) in the treatment of isolated unilateral hydrocephalus (IUH) due to membranous occlusion, to evaluate its efficacy and safety, and to define the benefits of neuronavigational guidance of the procedure. ⋯ NEFPFMO should be the primary treatment option in patients with IUH due to membranous occlusion of foramen of Monro. It reestablishes natural anatomical communication and provides real physiological cerebrospinal fluid flow. Neuronavigation is a useful adjunct of NEFPFMO.