No single radiological measurement was found to aid in the prediction of which patients would not respond to the first decompressive procedure. Furthermore, no operative finding was extraordinarily unique to any single patient. All but one patient in whom confirmation of a patent foramen of Magendie was made at repeated operation-that is, lysing of arachnoid veils, stent placement, unilateral tonsillar coagulation-had resolution of their syringomyelia. Surgical reexploration should be considered in cases of persistent syringomyelia.
We have found that the volume of the posterior fossa is significantly smaller in children with rickets versus age-matched control subjects. Furthermore, 29% of our study group had an associated CIM. We may hope that these data will aid in the further understanding of the pathophysiology of CIM in cases of metabolic bone disease.
Unfortunately, this is an area in which the literature is lacking. With this case as a nidus, studies are now necessary to determine the range of time necessary for Chiari I malformation-related hydromyelia to resolve.
The finding that prevertebral soft tissue thickens with age in patients with Chiari I malformation and functioning gag reflex alone may aid in the interpretation of soft-tissue injury following cervical spine injuries in this group.
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