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2.
Am J Case Rep ; 20: 719-722, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31105263

RESUMO

BACKGROUND Arthrogryposis multiplex congenita is a multifactorial syndromic or non-syndromic group of conditions consisting of multiple congenital contractures of the body, of unknown etiology. It is associated with a heterogenous group of disorders that include but are not limited to processes such as myopathic and neuropathic. Neural tube defect is a neuropathic disorder that incorporates myelomeningocele that might be either isolated or within a spectrum of multiple diseases. CASE REPORT This is a case report of a 28-day-old male born with lower limb arthrogryposis with myelomeningocele and Chiari II malformation in a Mediterranean population. CONCLUSIONS Lower extremity arthrogryposis with myelomeningocele and Chiari II malformation is a prenatal diagnosis that requires high clinical suspicion, early multidisciplinary intervention, and genetic counselling. As long as new approaches are being explored in the management of such cases, babies born now with neural tube defects can expect better quality of life.


Assuntos
Malformação de Arnold-Chiari/diagnóstico , Malformação de Arnold-Chiari/terapia , Artrogripose/diagnóstico , Artrogripose/terapia , Meningocele/diagnóstico , Meningocele/terapia , Malformação de Arnold-Chiari/complicações , Artrogripose/complicações , Humanos , Recém-Nascido , Masculino , Meningocele/complicações
3.
World Neurosurg ; 130: e9-e16, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31121369

RESUMO

BACKGROUND: Chiari I malformation (CMI) and the topics concerning it have been the subject of numerous discussions and polarizing controversies over the course of the last 20 years. METHODS: The opinions of 63 recognized international CMI experts from 4 continents, with a collective surgical experience of >15,000 CMI cases, were gathered through a detailed questionnaire. RESULTS: Three facts emerged from the analysis of the results: 1) Most of the replies showed a high level of consensus on most CMI-related topics. 2) Several topics, which had been considered controversial as recently as 10 years ago, are now more widely accepted. 3) The so-called 5-mm rule was rejected by 88.5% of the CMI experts who responded to the questionnaire. CONCLUSIONS: Sixty three recognized international CMI experts from 4 continents, with a collective surgical experience of >15,000 CMI cases were polled about a number of CMI topics. The results showed a high level of consensus, as well as a paradigm shift.


Assuntos
Malformação de Arnold-Chiari/diagnóstico , Malformação de Arnold-Chiari/cirurgia , Neurocirurgia/tendências , Atitude do Pessoal de Saúde , Consenso , Humanos , Inquéritos e Questionários
4.
Biomed Res Int ; 2019: 4829102, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31016190

RESUMO

This study aimed to summarize the clinical features, diagnosis, and treatment of Chiari malformation type I- (CM-1-) associated syringobulbia. We performed a literature review of CM-1-associated syringobulbia in PubMed, Ovid MEDLINE, and Web of Science databases. Our concerns were the clinical features, radiologic presentations, treatment therapies, and prognoses of CM-1-associated syringobulbia. This review identified 23 articles with 53 cases. Symptoms included headache, neck pain, cranial nerve palsy, limb weakness/dysesthesia, Horner syndrome, ataxia, and respiratory disorders. The most frequently involved area was the medulla. Most of the patients also had syringomyelia. Surgical procedures performed included posterior fossa decompression, foramen magnum decompression, cervical laminectomy, duraplasty, and syringobulbic cavity shunt. Most patients experienced symptom alleviation or resolution postoperatively. A syringobulbic cavity shunt provided good results in refractory cases. Physicians should be aware of the possibility of syringobulbia in CM-1 patients, especially those with symptoms of sudden-onset brain-stem involvement. The diagnosis relies on the disorder's specific symptomatology and magnetic resonance imaging. Our review suggests that the initial therapy should be posterior fossa decomposition with or without duraplasty. In refractory cases, additional syringobulbic cavity shunt is the preferred option.


Assuntos
Malformação de Arnold-Chiari/diagnóstico , Malformação de Arnold-Chiari/terapia , Bulbo/fisiopatologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Cefaleia/fisiopatologia , Humanos , Lactente , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Siringomielia/fisiopatologia , Resultado do Tratamento , Adulto Jovem
7.
Pediatr Emerg Care ; 35(4): e72-e75, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30870342

RESUMO

In this report, we describe a 13-year-old with opisthotonos as the presenting symptom of Chiari I malformation. This presentation is rare and has previously been reported only in infants. We describe the physical and radiologic findings, literature regarding Chiari malformation, and differential diagnosis of opisthotonos in this patient.


Assuntos
Malformação de Arnold-Chiari/diagnóstico , Adolescente , Malformação de Arnold-Chiari/cirurgia , Descompressão Cirúrgica/métodos , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Masculino , Espasmo/etiologia
8.
Acta Neurochir Suppl ; 125: 89-95, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30610307

RESUMO

BACKGROUND: Chiari malformations (CM) represent a group of anomalies characterized by descent of the cerebellar tonsils or vermis into the cervical spinal canal. These malformations can be associated with abnormalities such as hydrocephalus, spina bifida, hydromyelia, syringomyelia, curvature of the spine (kyphosis and scoliosis) and tethered cord syndrome. Hereditary syndromes and other disorders that affect growth and bone formation-such as craniosynostosis, Ehlers-Danlos syndromes and Klippel-Feil syndrome-can also be associated with CM. METHODS: The literature concerning treatment is large, and an extensive range of therapeutic protocols have been described. The literature is inclined in favour of surgery; however, there is controversy over when to perform surgery and which procedure is most appropriate. Lately, the indications for stabilization have been under discussion. RESULTS AND CONCLUSION: In this paper we review the literature and discuss the historical background, anatomical forms, pathophysiology, clinical presentation, relationships with other diseases and diagnostic procedures for these abnormalities.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico , Malformação de Arnold-Chiari/fisiopatologia , Humanos
9.
Sleep Breath ; 23(1): 327-332, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30187367

RESUMO

PURPOSE: Co-sleeping is common in children with co-morbid conditions. The aim of the study was to analyze the prevalence and determinants of parent-child co-sleeping in children with co-morbid conditions and sleep-disordered breathing and the impact on parental sleep. METHODS: Parents of consecutive children undergoing a sleep study filled in a questionnaire on co-sleeping. RESULTS: The parents of 166 children (80 boys, median age 5.7 years (0.5-21) participated in this study. The most common co-morbid conditions of the children were Down syndrome (17%), achondroplasia (11%), and Chiari malformation (8%). The prevalence of parent-child co-sleeping was 46%. Reasons for co-sleeping were mainly reactive and included child's demand (39%), crying (19%), nightmares (13%), medical reason (34%), parental reassuring or comforting (27%), and/or over-crowding (21%). Sixty-eight percent of parents reported that co-sleeping improved their sleep quality because of reassurance/comforting (67%), reduced nocturnal awakening (23%), and child supervision (44%). Forty percent of parents reported that co-sleeping decreased their sleep quality because of nocturnal awakenings or early wake up, or difficulties initiating sleep (by 77% and 52% of parents, respectively), whereas both positive and negative associations were reported by 29% of the parents. Co-sleeping was more common with children < 2 years of age as compared to older children (p < 0.001). CONCLUSIONS: Parent-child co-sleeping is common in children with co-morbid conditions and sleep-disordered breathing. Co-sleeping was mainly reactive and had both positive and negative associations with parental sleep quality. Co-sleeping should be discussed on an individual basis with the parents in order to improve the sleep quality of the family.


Assuntos
Dissonias/diagnóstico , Síndromes da Apneia do Sono/diagnóstico , Acondroplasia/diagnóstico , Acondroplasia/epidemiologia , Adolescente , Fatores Etários , Malformação de Arnold-Chiari/diagnóstico , Malformação de Arnold-Chiari/epidemiologia , Criança , Pré-Escolar , Comorbidade , Estudos Transversais , Síndrome de Down/diagnóstico , Síndrome de Down/epidemiologia , Dissonias/epidemiologia , Feminino , Humanos , Lactente , Masculino , Síndromes da Apneia do Sono/epidemiologia , Inquéritos e Questionários , Vigília , Adulto Jovem
10.
Pan Afr Med J ; 30: 146, 2018.
Artigo em Francês | MEDLINE | ID: mdl-30374392

RESUMO

Vitiligo is a relatively common multifactorial polygenetic dermatosis (0.5%-2% of general population) characterized by segmental or nonsegmental cutaneous depigmentation. Chiari malformation is a congenital cervico-occipital junction disease characterized by a migration of a part of the cerebellum through the foramen magnum.The association between these two pathologies is exceptional and poses a cause-effect problem. We here report the case of a 45-year old woman with no particular previous history who reported bilateral cervico-brachial neuralgias associated with thermal algesic dissociated sensory disorders lasting for 2 months. Cutaneous examination showed hypopigmented macular lesion on the neck and the posterior portion of the right forearm resistant to topical treatment based on strong corticosteroids (A). Brain MRI objectified Chiari malformation type II (B red arrow) with syringomyelia cavity at C6 (B white arrow). The patient underwent osteo-dural decompression of the posterior fossa with good neurological improvement and repigmentation of patches after 6 months. A few cases have been reported in the literature that show this association. Arguments in favor are: localization of lesions in dermatomes in correspondence with the malformation and regression after surgery. Etiopathogenesis of vitiligo is not clear, then several theories have been proposed to explain its occurrence;autoimmune theory, epidermal adhesion theory, biochemical theory and neuronal theory.This last seems to us to be the most likely explanation of this association. According to this theory the occurrence of skin lesions is due to the secretion of substances inducing melanocyte destruction by suffering neurons.


Assuntos
Malformação de Arnold-Chiari/diagnóstico , Descompressão Cirúrgica/métodos , Siringomielia/etiologia , Vitiligo/etiologia , Malformação de Arnold-Chiari/fisiopatologia , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Resultado do Tratamento , Vitiligo/terapia
11.
J Clin Neurosci ; 57: 180-182, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30145082

RESUMO

Quadriparesis and cardiovascular instability are not symptoms commonly associated with Chiari I malformation diagnoses, less so in a 3-month-old toddler. Chiari I malformations have a wide array of symptoms, varying with regard to both the nature of onset and the age of the patient presenting. This variation is illustrated in this report, presenting a novel description of a set of symptoms in a particularly young patient, a case lacking the common insidious nature of Chiari I malformation symptoms. Acute onset of cardiovascular instability, global hypertonia, hyperreflexia, and proximal upper limb weakness in a 3-month-old toddler are discussed. Parallels between the presented case and previous case reports are few, however some key features are distinguishable among similar cases. A successful posterior fossa craniectomy allowed the acutely unwell toddler to become a healthy, fully functional child. We believe this case contributes to elucidating the rare presentations of a curious pathology.


Assuntos
Malformação de Arnold-Chiari/diagnóstico , Malformação de Arnold-Chiari/cirurgia , Sistema Nervoso Autônomo/fisiopatologia , Craniotomia , Feminino , Humanos , Lactente , Reflexo
12.
Pediatr Neurosurg ; 53(6): 371-378, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30149388

RESUMO

This cross-sectional study investigates the prevalence and risks for psychiatric diagnoses in a large cohort of children with Chiari malformation type 1 (CM1) presenting for neurosurgical evaluation. Children between the ages of 6 and 17 years who were evaluated and diagnosed with CM1 at a neurosurgery clinic were identified. Eighty-six participants were recruited for this study with an average age of 11 years. Parents of participants completed a pediatric medical history questionnaire and a semistructured interview regarding the child's psychiatric, developmental, medical, and family history. A review of medical records was completed to complement interview data. Elevated rates of psychiatric diagnoses, including attention deficit hyperactivity disorder (ADHD) (22.1%), anxiety (12.8%), and depression (10.5%), were identified in the study population when compared to published norms in the general population documented by the American Psychiatric Association in 2013. In addition, elevated rates of psychiatric diagnoses in first-degree relatives of study participants were also identified. A 2-step binary logistic regression analysis revealed that maternal complications during pregnancy (Wald = 6.52, p = 0.01) increased the risk of a psychiatric diagnosis 9-fold. Premature birth (Wald = 6.79, p = 0.01) also significantly predicted a psychiatric diagnosis amongst participants. The current findings suggest a high prevalence of psychiatric illness in children with CM1. Pregnancy complications were associated with a high risk of a psychiatric diagnosis. Early CNS developmental disturbance may explain this relationship. Prematurity only slightly improved the prediction model. Limitations and future directions are discussed, including the cross-sectional nature of the present study, possible self-selection bias, and the importance of future investigation of other causative and/or associative factors of CM1, such as cognitive, psychiatric, and medical influences on health status.


Assuntos
Malformação de Arnold-Chiari/diagnóstico , Comorbidade , Transtornos Mentais/epidemiologia , Adolescente , Criança , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Transtornos Mentais/etiologia , Gravidez , Complicações na Gravidez , Prevalência , Inquéritos e Questionários
13.
Mediciego ; 24(2)jul.2018. Fig
Artigo em Espanhol | CUMED | ID: cum-71195

RESUMO

Introducción: la malformación de Chiari II es la más común dentro de los cuatro tipos de la clasificación y es la de mayor importancia clínica por su frecuente asociación con el mielomeningocele.Objetivo: presentar un caso cuya sintomatología resultó compatible con una malformación de Arnold Chiari tipo II, lo cual es útil como material de consulta para neonatólogos y neurocirujanos.Presentación del caso: neonato masculino, nacido por cesárea debido a desproporción céfalo-pélvica materna. La madre, residente en el Estado Plurinacional de Bolivia en un área alejada del centro de salud, acudió a solo a dos consultas prenatales. El tiempo de gestación fue de 39 semanas, el peso de 3 900 g y el puntaje de Apgar de 9/9. Llamó la atención el aumento de la circunferencia craneal y la presencia de un saco lumbar en protrusión por el que se veían las meninges y salía líquido cefalorraquídeo. Se cubrió la zona con apósito estéril y solución salina fisiológica, se inició el tratamiento con antibióticos de segunda línea y se realizó ultrasonido de cráneo transfontanelar.Conclusiones: ante un neonato con defecto lumbar y circunferencia cefálica superior al 90 percentil, el especialista debe tener en cuenta la posible existencia de malformaciones del sistema nervioso central (específicamente del tubo neural) e hidrocefalia como manifestaciones del síndrome de Arnold Chiari tipo II. Para confirmar el diagnóstico es útil, por su inocuidad e inmediatez, el ultrasonido de cráneo transfontanelar, y el neonato debe ser valorado por el especialista en neurocirugía para definir el tratamiento(AU)


Introduction: the Chiari II malformation is the most common within the four types of classification and is the most clinically important due to its frequent association with meningomyelocele.Objective: to present a case whose symptomatology was compatible with Arnold Chiari malformation type II, which is useful as reference material for neonatologists and neurosurgeons.Case presentation: male neonate, born by caesarean section due to maternal cephalopelvic disproportion. The mother, resident in the Plurinational State of Bolivia in an area far from the health center, attended only two prenatal consultations. The gestation time was 39 weeks, the weight of 3 900 g and the Apgar score of 9/9. The increase in the cranial circumference and the presence of a protruding lumbar sac through which the meninges were seen and cerebrospinal fluid came out attracted attention. The area was covered with sterile dressing and physiological saline solution, treatment with second-line antibiotics was started and ultrasound of the transfontanellar skull was carried out.Conclusions: before a neonate with lumbar defect and cephalic circumference greater than 90th percentile, the specialist must take into account the possible existence of malformations of the central nervous system (specifically the neural tube) and hydrocephalus as manifestations of the Arnold Chiari type II syndrome. To confirm the diagnosis, it is useful, because of its innocuousness and immediacy, the transfontanellar skull ultrasound, and the neonate must be evaluated by the specialist in neurosurgery to define the treatment(AU)


Assuntos
Humanos , Masculino , Recém-Nascido , Região Lombossacral , Meningomielocele , Hidrocefalia , Malformação de Arnold-Chiari/diagnóstico , Relatos de Casos
14.
Curr Pain Headache Rep ; 22(7): 49, 2018 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-29904826

RESUMO

PURPOSE OF REVIEW: Chiari malformations (CM) are a group of neuroanatomical pathologies resulting from overcrowding of the hindbrain. The purpose of this review is to characterize Chiari headache (CH) and describe diagnosis and treatment of the condition. RECENT FINDINGS: Recent research has helped solidify the criteria for diagnosis of CH. Imaging studies have expanded our understanding of the morphological features producing them and helped to better characterize the pathophysiology. Additionally, identifying this unusual headache disorder accurately has helped with specific treatment options. CH is a disabling condition which can effect multiple domains of a patient's life. The diagnostic criteria has improved, and we now have a better understanding of the pathophysiology and imaging findings associated with CH. Future research is warranted to find new treatment options for individuals suffering from this condition.


Assuntos
Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos
15.
Pediatr Neurosurg ; 53(4): 238-242, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29734193

RESUMO

BACKGROUND: Traditional teaching is that Chiari 1 malformations with syrinx should be operated as soon as possible. We present 2 cases of a radiologically proven Chiari 1 malformation with syrinx which were treated nonoperatively and improved radiologically. METHODS: Two children with an MRI-proven Chiari 1 malformations were followed up nonoperatively for 7 years (2010-2017). One was a boy aged 8 years and the other a girl aged 9 years at first presentation. Their parents were not interested in a surgical option and so it was decided to adopt a wait-and-watch policy. Both patients were followed up with a regular half-yearly clinical examination and yearly MRI studies (2010-2017). RESULTS: It was found that, in both of them, the initial cough during swallowing and the headache improved. Serial MRI showed that the hind-brain protrusion was reduced and syrinx diminished or resolved well. CONCLUSIONS: Some children with Chiari I and syringomyelia may show spontaneous resolution of symptoms and syringomyelia. Large registry studies will be needed to determine how likely it is that Chiari-associated syringes will resolve, and whether there are particular anatomic or neurologic differences between those who require surgery and those who don't.


Assuntos
Malformação de Arnold-Chiari/diagnóstico , Siringomielia/diagnóstico , Conduta Expectante/métodos , Malformação de Arnold-Chiari/diagnóstico por imagem , Criança , Feminino , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Literatura de Revisão como Assunto , Siringomielia/diagnóstico por imagem
16.
BMJ Case Rep ; 20182018 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-29622715

RESUMO

This is the first reported case of a Chiari 1 malformation in association with tuberculous (TB) meningitis. We present a case of a 23-year-old woman with a 2-week history nocturnal fever, vertigo, headache and projectile vomiting. She had nystagmus, scanning speech, bilateral papilloedema and ataxia. Cranial imaging showed a 10 mm tonsillar herniation. Posterior fossa decompression was done. Because the patient's gamut of symptoms was highly suspicious for a central nervous system infection, a lumbar tap was done which revealed TB meningitis. Four years later, after anti-TB medications and rehabilitation, all her symptoms except gait instability resolved.


Assuntos
Malformação de Arnold-Chiari/diagnóstico , Fossa Craniana Posterior/cirurgia , Descompressão Cirúrgica/métodos , Tuberculose Meníngea/diagnóstico , Malformação de Arnold-Chiari/fisiopatologia , Malformação de Arnold-Chiari/reabilitação , Malformação de Arnold-Chiari/terapia , Fossa Craniana Posterior/diagnóstico por imagem , Progressão da Doença , Feminino , Febre/etiologia , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Punção Espinal , Resultado do Tratamento , Tuberculose Meníngea/fisiopatologia , Tuberculose Meníngea/reabilitação , Tuberculose Meníngea/terapia , Vertigem/etiologia , Vômito/etiologia , Adulto Jovem
18.
J Clin Res Pediatr Endocrinol ; 10(4): 391-394, 2018 11 29.
Artigo em Inglês | MEDLINE | ID: mdl-29513222

RESUMO

Spontaneous intracranial hypotension (SIH) is a rare and potentially serious condition in childhood. Cerebrospinal fluid (CSF) volume depletion is thought to be the main causative feature for intracranial hypotension and results from a spontaneous CSF leak, often at the spine level. SIH is increasingly diagnosed in clinical practice, although it manifests a varied symptomatology. The downward displacement of the brain, sometimes mimicking a Chiari I malformation, has rarely been reported. We present a case of a SIH with Chiari I malformation accompanied by an unusual clinical presentation of persistent hypoglycemia.


Assuntos
Malformação de Arnold-Chiari/diagnóstico , Vazamento de Líquido Cefalorraquidiano/diagnóstico , Hipoglicemia/diagnóstico , Hipotensão Intracraniana/diagnóstico , Adolescente , Malformação de Arnold-Chiari/etiologia , Vazamento de Líquido Cefalorraquidiano/complicações , Diagnóstico Diferencial , Feminino , Humanos , Hipoglicemia/complicações , Hipotensão Intracraniana/complicações , Síndrome
20.
Childs Nerv Syst ; 34(6): 1169-1176, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29396718

RESUMO

OBJECTIVES: Chiari I malformation has been a well-recognized clinical entity; however, its occurrence among infants and toddlers is unusual. Their clinical presentations may be different from other age groups due to their lack of effective verbal communication. The authors analyze their personal series of patients focusing on symptomatology and MRI characteristics. Treatment methods, results, and outcome are analyzed in order to identify appropriate surgical management among infants and toddlers with Chiari I malformation. METHODS: The authors retrospectively reviewed 16 patients who were diagnosed and surgically treated between 2007 and 2014 during the first 3 years of life with minimum follow-up of 3 years. We focused on the presenting symptoms, magnetic resonance imaging findings, and surgical techniques used for posterior fossa decompression (PFD) and their postoperative outcome. RESULTS: Twelve patients (75%) presented with signs of headaches such as irritability, inconsolable crying, head grabbing, and/or arching back. Ten patients (62.5%) presented with oropharyngeal and/or respiratory symptoms such as emesis, choking, gagging, snoring, sleep apnea, breathing pause, and/or vocal cord palsy. Only one patient had segmental cervical hydromyelia. At the first surgery, ten patients had PFD with dural scoring (Type 1 procedure), while six others had PFD with duraplasty (Type 2 procedure) with thermal reduction of the cerebellar tonsils in four. Following the first operation, all initially had varying degrees of symptomatic improvement; however, seven patients subsequently had symptomatic recurrence. Persistent crowding at the PFD site on the postoperative imaging indicated greater risk of recurrences in both Type 1 procedure and Type 2 procedure groups. Of seven patients who needed a second operation, fivewere after Type 1 procedure and the two were after Type 2 procedure. The difference of recurrence rates between these two groups is not significant. CSF-related complications occurred in 4 out of 11 patients who had Type 2 procedure (one after primary decompression and three after the second decompression for recurrence). CONCLUSION: Young patients lacking effective verbal communication often present their Chiari I malformation differently from olderage groups. Behavioral changes indicative of headaches/irritability and oropharyngeal/respiratory symptoms are the primary presenting symptoms. The recurrence rate tends to be higher among the patients after Type 1 procedure (particularly those younger than 18 months) than after Type 2 procedure. We observed that duraplasty at primary or at redo PFD provides for better decompression and long-term outcome. However, one should keep it in mind that there is risk of CSF-related complications following duraplasty, particularly higher tendency after redo PFD.


Assuntos
Malformação de Arnold-Chiari/diagnóstico , Malformação de Arnold-Chiari/cirurgia , Pré-Escolar , Descompressão Cirúrgica/métodos , Feminino , Humanos , Lactente , Masculino , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/epidemiologia , Recidiva , Estudos Retrospectivos
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