ABSTRACT
Background: Persistent or worsening syringomyelia after foramen magnum decompression (FMD) for Chiari I malformation (CIM) can be challenging to manage. We present a previously unpublished surgical technique of FMD with concomitant cervical syringotomy in selected patients. Methods: A retrospective analysis of prospectively collected data was carried out. Patients who underwent FMD and expansion duraplasty (FMDD) with concomitant syringotomy were collected. Results: Three patients with CIM with high cervical syringomyelia who underwent FMDD with concurrent syringotomy were identified. All cases had an idiopathic CIM. Improvement in clinical symptoms was noticed in all patients. Early postoperative imaging (within 6 weeks-4 months) showed syrinx transverse diameter reduction in the range of 85-100%. There were no postoperative complications. Conclusion: FMDD with concurrent high cervical syringotomy through a standard approach in selected cases of CIM with high cervical syringes achieves clinical improvement without additional complications.
ABSTRACT
The treatment of hydrocephalus has changed in recent years with better imaging and introduction of endoscopic procedures as well as enhanced shunts. Indications of endoscopic third ventriculostomy (ETV) are now more refined with better quantification of outcome. This article reviews the current state of neuroendoscopy for infective hydrocephalus in children. The roles of third ventriculostomy as a primary procedure or after shunt malfunction, endoscopic interventions in multiloculated hydrocephalus and introduction of intraventricular lavage to salvage severely infected children are evaluated.
Subject(s)
Hydrocephalus/surgery , Neuroendoscopy/methods , Child , Female , Humans , Hydrocephalus/etiology , Infectious Encephalitis/complications , MaleSubject(s)
HIV Infections/complications , Leiomyosarcoma/etiology , Leiomyosarcoma/virology , Spinal Neoplasms/etiology , Spinal Neoplasms/virology , Actins/metabolism , Adult , Calmodulin-Binding Proteins/metabolism , Desmin/metabolism , Female , HIV/pathogenicity , HIV Infections/diagnostic imaging , HIV Infections/surgery , Herpesvirus 4, Human/pathogenicity , Humans , Leiomyosarcoma/diagnostic imaging , Magnetic Resonance Imaging , Positron-Emission Tomography , RNA, Viral/metabolism , Spinal Neoplasms/diagnostic imaging , Spinal Neoplasms/surgeryABSTRACT
We present our recent experience with fluorescein sodium videoangiography (FLVA) in the intra-operative evaluation of a patient with conus medullaris arteriovenous malformation (AVM). To our knowledge this is the first report in the literature of use of FLVA in the surgery of spinal AVM. Intra-operative FLVA was done to identify an early filling vessel and to obliterate the site of fistulous connection. This was correlated and confirmed with simultaneous indocyanine green videoangiography (ICGVA). The conus and cauda equina roots could be appreciated and manipulated in relation to this fluorescence. Obliteration was confirmed with FLVA and correlated with ICGVA. There was no untoward reaction to the dye injection. We conclude that FLVA is a useful adjunct in the surgical treatment of conus medullaris AVMs since it is a real time, noninvasive, radiation-free, easily reproducible technique allowing surgical manipulation through the operating oculars with simultaneous visualization of surrounding critical structures.
