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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. |
