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Dr. Ali Al-Bayati

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The patient  a child 4 years age was brought to the clinic 11-March-2000 with hydrocephalus  and syringomeylia of the cervical spinal cord and lumbosacral myeloschisis, which required urgent repair the next day after birth. VPS was inserted  in September-1996. The patient then another time came 24-March-2002 with cyanosis spells for two weeks, related to the head position and weak right upper limb  and occipital pain, progressing during sleep. The patient was shunted before and the syringomeylia dealt with shunting.

MRI done 01-January-2001 showed enlargement of the sac at the at the cervico-medullary junction with Arnold-Chiari malformation down to C4.  She was bitten by football 4 weeks ago, after what, she improved. She had swallowing difficulty  for 2 weeks, tremor of the tongue with pathologic reflexes right upper limb.

The patient was sent for another MRI with contrast, which showed decrease in the size of the sac and a small clot in the bottom of the ruptured sac. Despite that the patient is receiving Epanutin and Decadron, the condition of the patient continued to deteriorate and the cyanotic spells  became more frequent up to 40 attacks per day.

The patient was admitted to Al-Shmaisani hospital 6-April-2002 and was operated. In the sitting position, a wide posterior craniectomy was performed up to the course of the transverse sinuses and sigmoids. Laminectomy of C1-2-3 and 4 was done. The dura was opened in its entire course. Considering the very small volume of the posterior fossa, most of the brainstem and cerebellum were shifted downward below foramen magnum. Dissection of all abnormal thick membranes was done to obtain adequate CSF circulation.

Lyodura was used to have water-tight closure with redundant space for the neural structures. Routine closure of the wound.

The patient showed smooth postoperative recovery.

 

 
 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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