Negative pressure pulmonary edema following foramen magnum decompression for Chiari malformation type I.
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A 57-year-old obese female presented with vagal and hypoglossal nerve pareses, and magnetic resonance imaging revealed Chiari malformation type I. Standard surgical treatment for Chiari malformation type I was successfully performed. However, immediately after the patient was extubated, she developed signs of upper airway obstruction and chest radiography revealed pulmonary edema. Her ventilation was assisted by maintaining positive end-expiratory pressure at 8 cmH2O. Intravenous furosemide and hydrocortisone were administered. Her respiratory status improved 12 hours later, and she was extubated 3 days after the operation. Postextubational course was uneventful, and the patient was discharged 2 weeks after extubation. The initial neurological deficits had mostly disappeared by 10 months after the operation. This unusual case of negative pressure pulmonary edema indicates that obesity and lower cranial nerve paresis are further risk factors for pulmonary edema as a postextubational complication of surgical treatment. (+info)
Nomograms of the axial transverse diameter of the fetal foramen magnum between 14 and 40 weeks' gestation.
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OBJECTIVE: The purpose of this study was to create reference range nomograms of the axial transverse diameter of the fetal foramen magnum (TDFM) between 14 and 40 weeks' gestation. METHODS: This cross-sectional study included pregnant patients between 14 and 41 weeks' gestation. Inclusion criteria consisted of well-established dates (confirmed by early sonography) and nonanomalous singleton fetuses with intact amniotic membranes. Sonographic measurements included biparietal diameter, head circumference, abdominal circumference, femur length, humerus length, transcerebellar diameter, and sonographically estimated fetal weight. Values of the TDFM were each calculated as the mean of 3 separate measurements. The 5th, 50th, and 95th percentiles were estimated at each week of gestational age (GA) by least squares regression for the mean and SD of the TDFM as functions of GA. R(2) and associated P values for the relationships between the TDFM and other biometric measurements were calculated. RESULTS: The study included 602 consecutive patients meeting the inclusion criteria. The mean maternal age +/- SD was 27.5 +/- 6.4 years; median gravidity, 3 (range, 1-12); and median parity, 1 (range, 0-7). The mean TDFM was 13.5 +/- 3.7 mm. The reference curve formulas for the mean and SD of the TDFM (mm) were TDFM = -12.58 + GA/0.5616 - GA(2)/24.9 + GA(3)/2430.7, and SD(TDFM) = 1.05 - GA/19.4 + GA(2)/588.8. The TDFM correlated significantly and strongly with biparietal diameter, head circumference, abdominal circumference, humerus length, femur length, transcerebellar diameter, and estimated fetal weight (all R(2) >or= 0.90; all P < .0001). CONCLUSIONS: We present reference range nomograms of the TDFM between 14 and 40 weeks' gestation. (+info)
Motion of the cerebellar tonsils in the foramen magnum during the cardiac cycle.
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C1 and C2 nerve sheath tumors: analysis of 32 cases.
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BACKGROUND: C1 and C2 nerve sheath tumors are to be considered as a separate clinical entity because of their unique clinical presentation, relation to the adjacent structures and surgical approaches when compared to their counterparts in other regions. AIM: To present the clinical characteristics, radiological findings, operative approaches, and outcomes. SETTING AND DESIGN: Of the 32 patients, the study was retrospective in 22 patients and in 10 it was prospective. MATERIALS AND METHODS: Patients' case records were analyzed. Diagnosis was established by magnetic resonance imaging of craniovertebral junction. Patients were evaluated by Yasargil grading and operative procedure was done accordingly. RESULTS: In this series the tumors were multiple and had extradural extension and hourglass expansion. Surgical results were excellent in most patients when procedure was done early in the course of the disease. Best results in terms of complete removal and good neurological outcome were achieved with posterior or posterolaterlly located lesion. Of the 20 patients who had surgery by posterior approach, 19 (95%) patients had improvement postoperatively, while one (5%) patient remained unchanged. While of the 8 patients who had surgery by posterolateral approach, 6 (75%) had improvement postoperatively, one had no change and the other had neurological deterioration. CONCLUSION: C 1 and C 2 nerve sheath tumors are to be considered as a separate clinical entity. Operative results and recovery of patients are excellent when tumor is located posterior or posterolaterally and surgical procedure is done early in the disease course. (+info)
Basilar invagination, Chiari malformation, syringomyelia: a review.
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