Heart surgery performed with circulatory arrest as the predominant support strategy is associated with a higher risk of delayed motor development and neurologic abnormalities at the age of one year than is surgery with low-flow bypass as the predominant support strategy.
Caudal herniation of the hindbrain, indistinguishable from the Chiari I deformity, may occur after the establishment of spinal subarachnoid shunts and become symptomatic years after the procedure. Examples are presented and others are cited from the literature. It is proposed that the force responsible for the displacement is the difference in pressure between the cranial and spinal compartments. On the basis of these observations and other considerations as well, a similar process, disproportionate absorption of cerebrospinal fluid from the spinal region, might account for the spontaneous form of the Chiari I deformity.
A case of villous hypertrophy or bilateral papilloma of the choroid plexus of the lateral ventricles is reported. The child exhibited known features associated with overproduction of cerebrospinal fluid, hydrocephalus that was difficult to control, ascites after ventriculoperitoneal shunting, and relief after surgical removal of the papillomatous tissue. A unique feature is the complexity of the telencephalic choroid plexuses as shown by computerized tomography and ultrasound in the newborn period.
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