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PubMed1976

Chronic tonsillar herniation: an attempt at classifying chronic hernitations at the foramen magnum.

A system is presented for the classification of chronic herniations of the cerebellar tonsils in the absence of space-occupying intracranial lesions, based on a survey of the literature and 13 own cases. The Arnold-Chiari malformation in adults typically involves herniation of the cerebellar tonsils instead of herniation of the vermis as is typical when it occurs in infancy. Identification of chronic tonsillar herniation with the Arnold-Chiari malformation in adults was thought to require at least one other sign of the Arnold-Chiari complex, e.g. a medullary deformity. Cases for which chronic herniation and sclerosis of the cerebellar tonsils present as the only nervous lesion are classified as "chronic tonsillar herniation". Such cases may manifest with neurological symptoms during adult life, or they may be found incidentally at autopsy. Attention is drawn to the occurrence of chronic tonsillar herniation in 7 infants and children where it apparently represents a cause of sudden unexpected death. The overlap between chronic tonsillar herniation and the Arnold-Chiari malformation of adults is discussed in regard to the frequence of associated osseous anomalies, hydrocephalus and syringomyelia.

Adolescent↗
PubMed1993

The suboccipital transcondylar approach to the clivus and cranio-cervical junction for ventrally placed pathology at and above the foramen magnum.

The dorsolateral suboccipital transcondylar approach for pathology anterolateral or ventral to the neuraxis around the lower clivus and brainstem was used in 10 patients with a variety of different pathological problems: Key features of the approach include exposure and mobilisation of the vertebral artery and resection of the postero-medial portion of the atlanto-occipital joint. Despite the excellent access achieved additional exposure may be required in some patients with strictly anterior pathology or a lesion above the mid-clivus.

Adult↗
PubMed1994

Removal of aneurysmal bone cyst in the area of C1, C2 and foramen magnum. Follow-up of surgical osteoplastic repair by means of 3 D CT studies 15 years later.

First, the author relates his memories of his first encounter with the new Editor-in-Chief of the Acta Neurochirurgica in 1957 and the reasons why it made such an unforgettable impression. Next, follows a discussion of the technical difficulties in the treatment of spinal aneurysmal bone cysts, which may produce extensive destruction of its bony elements. The relatively rare occurrence of these lesions and resulting limited experience provide insufficient grounds for developing rigid rules of surgical treatment. Their treatment must rather rely on experience by means of examples (paradigms). The present author's principles of surgical strategy are total removal of these cysts and repair by means of stabilizing bony autotransplants. A description is given of an unusual case of an aneurysmal bone cyst localized in the cervical-occipital transition area in which 3 D CT images give a better view on stabilization reached by osteoplastic repair of the destroyed structures than can be achieved with previous imaging methods.

Bone Cysts, Aneurysmal↗
PubMed1981

Simultaneous cerebral and spinal fluid pressure recordings. 2. Cerebrospinal dissociation with lesions at the foramen magnum.

Simultaneous intraventricular and intraspinal pressure recordings in erect patients with obstructive lesions of th CSF pathways reveal differences in pressure which are frequently transitory and produced by pulsation. In non-acute cases without papilloedema but with suspected hindbrain hernia delay in equalization after pressure pulses may be demonstrated, and after Valsalva's manoeuvre differences between the head and the spine may be generated transiently and be responsible for clinical symptomatology. The particular clinical features related to hindbrain hernia are syringomyelia, cough headache, cough syncope, and lower cranial nerve signs with oscillopsia and cerebellar ataxia. Correction of the pressure dissociation is often associated with marked clinical improvement. It is suggested that this form of testing may be of relevance as an indication for operation and also for monitoring the progress of post-operative patients.

Brain Diseases↗