Neurosurgery clinics of North America
-
The Chiari II malformation and associated hydrosyringomyelia represent a complex spectrum of anatomic changes and clinical presentations whose management is rapidly changing as more is discovered about the natural history of these patients. Trends toward earlier operation on milder symptoms in selected patients may lead to improved neurologic outcome in these patients.
-
Cervical spina bifida, either occult or overt, is relatively uncommon. These lesions tend to be associated with other abnormalities of the central nervous system and spine. For the occult dysraphic lesions, a Klippel-Feil syndrome is a particular association, especially the type I variety. ⋯ In both the occult dysraphic states and spina bifida cystica, there is underlying tethering of the cervical spinal cord, which can cause late neurologic deterioration, and surgical treatment is indicated both for cosmetic reasons and to untether the spinal cord. Children with spina bifida cystica may have neurologic dysfunction that may not be evident at birth or in the first few months of life but may be identifiable as the child grows older. One needs to be cautious about providing too optimistic a prognosis with respect to neurologic dysfunction based on a neonatal examination and to recognize that the appearance of neurologic deficits may not indicate deterioration.