11/23. Seven distinct coexistent cranial and spinal anomalies.Existence of multiple cranial and spinal anomalies in spina bifida is well known; however, coexistence of seven different severe anomalies is extremely rare. The location of the anomalies, the patient's age and presentation are other interesting aspects of the presented case. CASE REPORT: A 1-year-old girl with an enlarged head and big, infected lumbosacral myelomeningocele (MMC) was admitted to the emergency department in a comatose state. Further investigations revealed hydrocephalus, Chiari malformation, syringohydromyelia, split cord malformation, dermal sinus tract, lumbosacral MMC, and tethered cord. Unfortunately, the patient died 3 days after admission because of meningitis and sepsis. DISCUSSION: Coexistence of seven different craniospinal anomalies is extremely unusual. Further investigations with magnetic resonance imaging for associated anomalies, early shunt placement and MMC repair are required to prevent this life-threatening condition in spina bifida.- - - - - - - - - - ranking = 1keywords = meningocele (Clic here for more details about this article) |
12/23. Tegmental dehiscence and brain herniation into the middle ear cleft.The tegmen tympani may occasionally be breached by herniation of the temporal lobe with or without dural cover. The clinical presentation may be obvious with CSF otorrhoea but less so with apparent middle ear effusion, CSF rhinnorrhoea, conductive hearing loss, recurrent meningitis or intracranial sepsis. diagnosis requires suspicion of the condition, which may be aided by radiological imaging. Surgical repair is to be recommended: various techniques are available but bone enveloped by fascia placed by subtemporal approach is preferred. The features of this problem are highlighted by four cases.- - - - - - - - - - ranking = 0.62188978655758keywords = herniation (Clic here for more details about this article) |
13/23. Post-traumatic syringomyelia, an update.Post-traumatic and post-arachnoiditic syringomyelia is described in 31 patients from the Midland Centre for neurosurgery and neurology (MCNN). It is suggested that the mechanisms may be similar in the two groups and that treatment is best directed to disabling the likely filling mechanisms by opening up the cerebrospinal fluid (CSF) pathways and deliberately leaving the dura open to create an artificial meningocele. It is suggested that drainage on its own is inappropriate but that when drainage of the syrinx is chosen as an ancillary technique then syringopleural drainage may be the procedure of choice.- - - - - - - - - - ranking = 1keywords = meningocele (Clic here for more details about this article) |
14/23. ventriculoperitoneal shunt in cryptococcal meningitis with hydrocephalus.Fourteen patients with cryptococcal meningitis were reviewed. All patients had a ventriculoperitoneal shunt for hydrocephalus. Early recognitions and prompt relief of hydrocephalus were useful for eight patients who showed rapid deterioration of consciousness or signs of cerebral herniation. There was no surgical response in four patients who had had weeks of confusion or mental change. It seems, therefore, that the duration of disturbance of consciousness or change of mentality before shunting is critical in determination of the outcome of the treatment. Ventricular shunting was effective in relieving papilledema in five patients. However, the surgery did not prevent the development of papilledema to optic atrophy and subsequent blindness in two patients. Hence, in addition to hydrocephalus with increased intracranial pressure, conditions such as direct invasion of the optic pathways by cryptococcus neoformans or optochiasmatic arachnoiditis may be responsible for the visual failure. Ventricular shunting was also helpful in restoring paraparesis in one patient. Of the cerebrospinal fluid determinations, low protein concentration was a favorable indicator for surgery. Of the seven patients who received the surgical procedure before the start of antifungal therapy, four showed a significant improvement despite active infection of the central nervous system. None of the seven patients deteriorated because of the surgical operation. Thus, active stage of cryptococcal meningitis does not contraindicate the necessity of shunting, and premedication with antifungal drugs is unnecessary. Also, no shunt-related morbidity and mortality was seen in this study.- - - - - - - - - - ranking = 0.12437795731152keywords = herniation (Clic here for more details about this article) |
15/23. Purulent meningitis due to spontaneous anterior sacral meningocele perforation. Case report.A 36 year old woman with anterior sacral meningocele developed a purulent meningitis secondary to the rupture of the meningeal sac into the rectum. The value of neuroradialogical studies, especially CT, is emphasized.- - - - - - - - - - ranking = 5keywords = meningocele (Clic here for more details about this article) |
16/23. Meningoradiculoneuritis mimicking vertebral disc herniation. A "neurosurgical" complication of Lyme-borreliosis.We report on 3 patients with meningoradiculoneuritis (MRN) due to Lyme-borreliosis (LB), which presented clinically as vertebral disc herniation. In 2 cases the underlying infection was discovered only after unsuccessful neurosurgical treatment. In the differential diagnosis between MRN and disc herniation the following criteria are suggestive of MRN and should raise suspicion of a non-discogenic aetiology: history of tick bite or erythema chronicum migrans, fever or general malaise, mono- or oligoradiculopathy with absent or insignificant lumbar pain and complaints of a burning character of the radiating pain. In suspicious cases we recommend blood investigations including antibody determination against borrelia burgdorferi and CSF investigations including cell count and cytology, protein and glucose determination, nephelometry and isoelectric focusing to exclude MRN and other conditions that may mimic disc herniation.- - - - - - - - - - ranking = 0.87064570118062keywords = herniation (Clic here for more details about this article) |
17/23. Mondini's dysplasia with recurrent meningitis.This report describes the diagnosis and surgical management of two patients with similar inner ear malformations resulting in recurrent otitic meningitis. Each patient had a meningocele presenting through the oval window associated with Mondini's anomaly. Details of radiographic diagnosis and surgical management strategies will be discussed and long-term follow-up presented.- - - - - - - - - - ranking = 1keywords = meningocele (Clic here for more details about this article) |
18/23. Stab wounds at the craniocervical junction.Between 1976 and 1984, 11 patients with stab wounds at the craniocervical junction were seen in the Department of neurosurgery at Groote Schuur Hospital. The injury usually occurred in males, and the left side was predominantly involved. Because of the anatomical features of this region, the penetrating instrument is deflected by the occipital squama into the atlantooccipital or atlantoaxial interspace, and an almost predictable syndrome occurs. The dura mater is penetrated, so that cerebrospinal fluid leakage and meningitis are common complications (meningitis occurred in 5 patients). A meningocele may develop at this site and did occur in 4 patients, but only 2 required surgical repair. Because of the exposed position of the vertebral artery at this level, this vessel was injured in 4 patients; an arteriovenous fistula developed in 2, vertebral artery occlusion occurred in 1, and a false aneurysm developed in another patient. The neurological deficit varied in magnitude, was often transient, affected the upper limbs more than the lower, was asymmetrical (suggestive of lateralized injury), and at times showed a remarkable tendency to recover. awareness of the existence of this syndrome may help in forestalling complications. The only warning sign may be an insignificant wound in the suboccipital or retromastoid region.- - - - - - - - - - ranking = 1keywords = meningocele (Clic here for more details about this article) |
19/23. A new, treatable source of recurrent meningitis: basioccipital meningocele.A 19-month-old boy suffered eight episodes of bacterial meningitis. During the ninth episode a meningocele of the basioccipital clivus communicating with the nasopharynx was discovered. Identification of the organism causing the episodes of meningitis was not helpful in pointing to the site of this congenital anatomic defect. Surgical closure of the defect has prevented further recurrences.- - - - - - - - - - ranking = 5keywords = meningocele (Clic here for more details about this article) |
20/23. Scintigraphic cerebral spinal fluid leak study in a child with recurrent meningitis after resection of a frontal meningocele.An In-111 DTPA cerebrospinal fluid (CSF) leak study was performed on a 3-year-old boy admitted with recurrent meningitis. He was born with a congenital encephalocele that was surgically resected at 7 days-of-age. A residual skull floor defect with a recurrent tumor of the nasal radix was clinically suspected. Computed tomography and MRI scans could not confirm or rule out the presence of a CSF leak. The scintigraphic study clearly demonstrated a leak into the left naris. A large leptomeningeal cyst extending down into the left nares was resected and a defect in the left frontal calvarium, identified as the source of the CSF leak, was repaired at surgery.- - - - - - - - - - ranking = 4keywords = meningocele (Clic here for more details about this article) |
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