Infarction in the vertebrobasilar system presenting as a posterior fossa mass lesion is extremely rare in children. We recently studied and treated a 9-year-old boy with cerebellar infarct produced by angiographicalh/ confirmed Type I fibromuscular dysplasia of the vertebral artery, complicated by a dissecting aneurysm. This case appears to be the first reported in the literature. (Stroke 1988; 19:521-524) I nfarction in the vertebrobasilar system presenting as a posterior fossa mass lesion is extremely rare in children. Of only 21 cases published in the literature, the cause was unknown in half. The etiologic factors in the others were trauma in four cases, infection in three cases, and dehydration, cervical spine anomaly, and basilar artery migraine in one case each. A congenital vascular anomaly was implicated only once. 1 We recently treated a 9-year-old boy with cerebellar infarct produced by Type I fibromuscular dysplasia (FMD). Angiography confirmed this diagnosis and revealed a dissecting aneurysm. To our knowledge this is the first case of this type reported in the literature.
Case ReportThis 9-year-old boy was well until July 15, 1986, when he had a 10-minute episode of loss of consciousness, ocular deviation, and myoclonus in the upper extremities. Similar episodes accompanied by vomiting were repeated 2 and 4 days later. He was admitted to a local hospital on July 21, 1986, when computed tomography (CT scan) was performed and he was transferred to our hospital. His medical history was unremarkable. His 36-year-old mother had suffered from convulsive seizures between the ages of 10 and 20 years.The findings of a general physical examination were normal. Neurologic examination revealed a somnolent boy who opened his eyes and responded to simple commands when aroused. He had weakness of the right lateral rectus muscle and no papilledema; the other cranial nerves were normal. His motor function showed general hypotonia, hyporeflexia, and flexor plantar responses. His gait was ataxic.From the
A case of a radiation-induced osteochondroma arising from the vertebral body of T4 in an 18-year-old man is reported. The patient presented with a history of progressive left lower extremity weakness. At 7 years of age, he had undergone resection of a cerebellar medulloblastoma and received adjunctive craniospinal irradiation and systemic chemotherapy. Both CT and MR imaging revealed an extradural mass contiguous with the posteroinferior endplate of the T4 vertebral body. This case indicates that radiation-induced osteochondroma should be considered in the differential diagnosis of patients with symptoms of myelopathy or nerve root compression and a history of radiation therapy involving the spine in childhood.
ResumenEl tratamiento quirúrgico de la malformación de Chiari tipo I consiste en realizar una descompresión ósea suboccipital. Está descrito que pueden producirse complicaciones derivadas de la cirugía, sobre todo si se realiza apertura dural y posterior cierre con injerto (duroplastia). Una de las más importantes por su difícil manejo, es la fístula de líquido cefalorraquídeo en la zona quirúrgica.Objetivo. Llevar a cabo una revisión postquirúrgica, donde analizaremos la evolución de los pacientes y la correlación de las complicaciones respecto al tipo de plastia dural usada.Material y métodos. Se ha realizado un estudio retrospectivo de los pacientes intervenidos en nuestro centro entre el año 1997 y 2008, ambos inclusive, recogiendo un total de 36 pacientes. A todos ellos se les realizó un estudio pre y postoperatorio con resonancia magnética craneoespinal, así como un examen neurológico antes y después de la intervención. La intervención quirúrgica consistió en una descompresión ósea suboccipital, junto con la extirpación del arco posterior de C1 o C2 (dependiendo del descenso amigdalar), y duroplastia con injerto autólogo (pericráneo) o con injerto heterólogo (Gore-tex).Resultados. Tras un seguimiento medio de 2 años obtuvimos los siguientes resultados clínicos: excelente (55%), si hubo gran mejoría clínica; bueno (29%), si hubo leve mejoría; y malo (16%), si no hubo mejoría o hubo empeoramiento. En los 30 pacientes a los que se les realizó duroplastia (18 plastia artificial, 12 plastia autóloga de pericráneo occipital), aparecieron 6 casos de fuga de líquido cefalorraquídeo, no existiendo asociación significativa entre el tipo de plastia dural y la presencia de fístula.Conclusiones. Los síntomas que mejoran en mayor medida en los pacientes intervenidos en nuestro centro son la cefalea, el dolor cervical y el mareo. A pesar de existir mayor número de fístulas de líquido cefalorraquídeo en el grupo de pacientes con plastia artificial respecto al grupo con plastia de pericráneo, no es un hallazgo significativo.PALABRAS CLAVE: Malformación de Chiari I. Duroplastia. Fístula de LCR. Pseudomeningocele. Siringomielia.
Postoperative complications in Chiari I malformation: duroplasty and cerebrospinal fluid leak
SummaryThe surgical treatment of Chiari I malformation is to carry out a suboccipital decompression. It is described that postoperative complications may occur, especially if the dura is open and closed using a graft (duraplasty). Among them, one of the most important events due to its difficult handling is cerebrospinal fluid leak through the suture line.Objective. To conduct a postoperative review to analyze the outcome of the patients and the occurrence of complications depending on the dural plasty used.Material and methods. A retrospective study was carried out between 1997 and 2008, both inclusive, where we assessed 36 patients. All of them were studied with preoperative and postoperative craneoespinal magnetic resonance, and by a thorough clinical examination performed before and after the surgery. Th...
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