A 51-year-old man presenting with radiculopathy a rare cervical dural arteriovenous fistula (AVF) is reported. Angiography revealed that the cervical dural AVF was fed mainly by the left C-3 and C-4 radicular arteries and drained into the internal vertebral venous plexus with no communication with intradural structures. The dural AVF was treated surgically after embolization therapy. Although the AVF showed mass effect on computerized tomography (CT) scanning, abnormal vessels, which were suspected to drain the AVF, were observed intraoperatively to compress the left C-4 and C-5 nerve root sleeves. After resection of these abnormal epidural vessels, monoparesis of the left proximal upper extremity was markedly improved. In this patient, dynamic CT scanning was useful in the initial diagnosis, and the preoperative embolization therapy was very effective.
Object. Cervical flexion myelopathy is a rare condition that mainly affects adolescent boys. In recent years, avoidance of neck flexion has been advocated as the treatment for cervical flexion myelopathy, and treatment with a cervical collar and surgery in which fusion of the cervical spine is performed have been found to be effective. However, previously reported series contained only a limited number of patients. The authors report their experience with treating 10 male patients in whom surgery was performed to correct cervical flexion myelopathy, and they evaluate the patients' surgical outcome.Methods. The authors performed anterior decompressive surgery and fusion in the cervical spine by using a long bone graft after resection of one or two vertebrae in seven patients. The other three patients underwent posterior fusion of four or five laminae.After surgery, symptom progression was stopped in all patients, muscle strength improved in seven, and sensory disturbance was alleviated in another two. However, the muscular atrophy in the upper extremities, which was evident in nine patients preoperatively, improved in only two.Conclusions. Because some neurological improvement was seen in nine of 10 patients, it is believed that surgical fusion of the cervical spine is an effective treatment for patients with cervical flexion myelopathy.
Objective-To determine if slight descent of the cerebellar tonsils (< 5 mm below the foramen magnum; tonsillar ectopia) may cause surgically treatable symptomatology. Methods-A consecutive series of nine symptomatic patients with tonsillar ectopia seen between December 1990 and March 1993 are reported on. The same number of age and sex matched controls were selected at random from outpatients. Twelve asymptomatic subjects with tonsillar ectopia were found among 5000 people between January 1991 and March 1996. Diagnosis of tonsillar ectopia was based on midsagittal MRI. Results-Patients presented mainly with chronic intractable occipital dull pain, vertigo, and dysequilibrium. In all patients MRI showed normal brain structure except for tonsillar ectopia (-2.9 (SD 0.8) mm), which has historically been thought to be of no clinical relevance. In the control group the tonsilar position was +2.1 (SD 2.8) mm (p<0.01). Neurotologically abnormal findings were detected with a monaural speech integration test (100%), eye tracking test (56%), optokinetic nystagmus test (89%), and visual suppression test (67%) which strongly suggested a CNS lesion. In accordance with the results of MRI and precise neurotological examination, posterior fossa decompression surgery was carried out, followed by improvement of preoperative symptoms and less severity of neurotological abnormalities in all patients. Conclusion-Tonsillar ectopia could cause neurological symptoms in small populations, which were surgically treatable. Neurotological assessment was necessary to verify the aetiological relation between tonsillar ectopia and various symptoms. (J Neurol Neurosurg Psychiatry 1998;64:221-226)
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.