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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ten infants with spina bifida cystica were investigated during life by simultaneous ventricular and intraspinal CSF pressure recordings, and 11 post-mortem specimens were studied by means of crystic resin castings of the ventricles. The results indicate marked pressure differentials between the lateral ventricles and intraspinal CSF pathways, which contribute to the moulding of the Arnold-Chiari malformation as a sliding hernia. Similar pressure differentials may exist at the incisura, with moulding of tissues producing blockage of the aqueduct and the subarachnoid pathways. A valvular action was demonstrated, in which baseline pressure differences were exaggerated by the infant's straining (e.g. crying, sucking), and it seems that complete dissociation between the two pressures may develop as a result of periods of partial dissociation. Removal of the meningocele sac increased the peaks in recordings of intraspinal pressure produced by straining. If it is carried out when there is a valvular effect, it seems that it will hasten the onset of established ventriculo-spinal pressure dissociation and uncompensated hydrocephalus by leading to impaction of the Arnold-Chiari malformation in the foramen magnum. The results indicate that even after birth the CSF pathways of babies with spina bifida cystica are in a plastic and changeable condition, with competition between constricting and distending forces. The demonstration that pressures tend to be low in the spine and to become lower before exacerbation of hydrocephalus suggests that all the intracranial manifestations of spina bifida cystica may be due to low intraspinal pressure, which results from initial failure of the neural tube to close during embryogenesis.
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PMID:Cerebrospinal fluid pressure-gradients in spina bifida cystica, with special reference to the Arnold-Chiari malformation and aqueductal stenosis. 110 12

Between 1982 and 1986, 66 patients suffering from traumatic frontobasal CSF fistulas were treated neurosurgically i.e. via a transcranial approach. In 68% an additional transcranial space-occupying lesion a direct open endocranium and/or a large basal cerebral hernia were found. The cases and relevant findings are discussed, followed by deliberations on the points enumerated below: --diagnostic, especially neuroradiological advances --problems of indications for surgery --the problem of the best possible surgical approach Both cranial and rhinological approach have their pros and cons. Their indications agree only partly, so that the choice of the method depends especially on the individual pathology. Progress has been achieved in recent years both neurosurgically and rhinologically. Neurosurgical results have been improved upon, and postoperative complications after cranial approach are now rare. Essential factors, apart from selecting the best possible time for surgery, are: --adequate intracranial debridement --the use of a microsurgical technique, as well as application of a various brain-protective, measures as stated in this article. Further progress is fundamentally based on best possible mutual cooperation between the disciplines involved, paying increased attention in future to endocrinological problems.
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PMID:[The neurosurgical treatment of traumatic fronto-basal spinal fluid fistulas. 66 cases (1982-1986)]. 197 67

300 patients with traumatic fronto-basal CSF fistulae were treated neurosurgically from 1967 to 1989, i.e. via a transcranial approach. An additional intracranial space occupying lesion, a direct open endocranium and/or a large basal brain hernia was found in 68%. The following aspects were discussed: progress in establishing the exact anatomical diagnosis, especially neuroradiological advances; questions of the indication for surgery; the problem of the optimal surgical approach. Both the cranial and the rhinological approach have advantages and disadvantages. Their indications only partly coincide, so that the choice of method depends especially on the individual pathology. Advances were made in recent years in terms of neurosurgery as well as of rhinology. The neurosurgical results could be improved, and postoperative complications have become rare after the cranial approach. Besides the optimal choice of the time of operation, the following factors are important: an adequate intracranial debridement; a microsurgical technique entailing as little damage to surrounding tissue as possible and various specially mentioned brain-protective measures. An optimal collaboration between the specialties involved is the basis for further progress. More attention must be paid to endocrinological problems in the future.
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PMID:Neurosurgical treatment of traumatic frontobasal CSF fistulae in 300 patients (1967-1989). 227 Jul 85

We examined the MR appearance of the hindbrain deformity, including the upper cervical spinal canal and craniovertebral junction, in 33 patients with Chiari II malformation. In this disorder, there is impaction at birth of the medulla and cerebellar vermis into the upper cervical spine, resulting in obliteration of the subarachnoid space and scalloping of the dens. Spinal canal enlargement during the child's growth, combined with dorsal displacement of neural tissue, eventually causes marked widening of the precervical subarachnoid space. This enlargement may simulate an intradural mass. Our series documents the changes seen at birth and the progression of the widened precervical space through the first and second decades. Twelve (36%) of the 33 patients studied were symptomatic, with brainstem or longtract symptomatology, and 11 of these required surgery. This group was compared with the remaining 21 asymptomatic Chiari II patients to identify MR features associated with clinical deterioration. The level of descent of the hindbrain hernia was critical; eight of 12 symptomatic patients had a cervicomedullary kink at C4 or lower, while no asymptomatic patients had a fourth ventricle, medulla, or kink below C3-C4. The precervical cord subarachnoid space was slightly wider in asymptomatic patients, although there was great overlap. In five patients with follow-up scans, this space was seen to increase in width after laminectomy. A CSF flow void was present in the precervical space in about 25% of patients in both groups. In nine of 12 symptomatic patients, C1 arch indentation of the dura (causing significant compression) was confirmed surgically. However, seven (33%) of the 21 asymptomatic patients also had this appearance. Absolute measurement of the anteroposterior diameter of the canal at C1 ranged from 11 to 25 mm in both groups. Retrocollis, which persisted despite sedation for MR, was seen in two patients, both symptomatic. Recognition of the vermis, medullary kink, cervical cord, C1 arch, fourth ventricle, and precervical space in Chiari II patients is fundamental to the analysis of symptoms in
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PMID:MR imaging of hindbrain deformity in Chiari II patients with and without symptoms of brainstem compression. 251 97

Methionine-enkephalin (ME-IR) and beta-endorphin (BE-IR) immunoreactive material CSF concentrations have been measured in subjects of different ages affected by lumbar or cervical disk hernia. The two peptides exhibited different age-related trends. ME-IR levels rose significantly with age while no changes were observed in the case of BE-IR.
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PMID:Age-related changes of methionine-enkephalin and beta-endorphin/beta-lipotropin immunoreactivity in human CSF. 297 45

Technological advances in neuroradiology and the development of skull base surgery in neurotology have improved diagnosis and management of lesions eroding the tegmen tympani. The diagnosis of brain hernia is to be suspected in patients with a history of complicated chronic ear surgery and a slowly developing pulsatile mass with CSF leak. Patients are best evaluated in the upright position, with an otomicroscope and by magnetic resonance imaging (MRI). Over 6 years, our group has treated seven patients with eight space-occupying lesions eroding the tegmen. Five of the lesions were repaired with a temporalis muscle flap, 2 with fascia and bone, and 1 with Marlex. A review of new technology in the diagnosis of brain hernia and a modification of previous techniques is given.
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PMID:Brain herniation and space-occupying lesions eroding the tegmen tympani. 365 64

We present three cases of endaural brain hernia and a method of repair using sculptured mastoid cortical bone. The literature is reviewed to illustrate etiology, pathology, clinical presentation, and management options of this uncommon clinical entity. We classify the hernias as pedunculated or sessile, with associated factors such as viability of herniated brain, infection, CSF leak, and neurologic complications. A management scheme is proposed encompassing surgical options now available and their attendant risks and complications.
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PMID:Endaural brain hernia: repair using mastoid cortical bone. 407 37

Simultaneous intraventricular and intraspinal pressure recordings in erect patients with obstructive lesions of th CSF pathways reveal differences in pressure which are frequently transitory and produced by pulsation. In non-acute cases without papilloedema but with suspected hindbrain hernia delay in equalization after pressure pulses may be demonstrated, and after Valsalva's manoeuvre differences between the head and the spine may be generated transiently and be responsible for clinical symptomatology. The particular clinical features related to hindbrain hernia are syringomyelia, cough headache, cough syncope, and lower cranial nerve signs with oscillopsia and cerebellar ataxia. Correction of the pressure dissociation is often associated with marked clinical improvement. It is suggested that this form of testing may be of relevance as an indication for operation and also for monitoring the progress of post-operative patients.
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PMID:Simultaneous cerebral and spinal fluid pressure recordings. 2. Cerebrospinal dissociation with lesions at the foramen magnum. 731 57

We studied the effects on CSF dynamics at the foramen magnum and the clinical significance of the abnormal tonsillar motion in 14 patients with Chiari type I malformation and 14 control subjects using cine phase-contrast MRI. Dynamic MRI consisted of axial and sagittal cine phase-contrast sequences. CSF and tonsillar motion were qualitatively and quantitatively evaluated, and the subarachnoid space at the foramen magnum measured. In Chiari patients, cine phase-contrast MRI detected the abnormal pulsatile motion of the cerebellar tonsils, which produced a selective obstruction of CSF flow from the cranial cavity to the spine. The amplitude of the tonsillar pulsation and the severity of the arachnoid space reduction were associated with the symptom of cough-strain headache, but not with the presence of syringomyelia. The finding of abnormal valve dynamics of the cerebellar hernia revealed by cine phase-contrast MRI conforms to the pathophysiologic mechanisms suggested in pressure register studies and opens a new possibility in the presurgical assessment of Chiari patients with exertional symptoms.
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PMID:Motion of the cerebellar tonsils in Chiari type I malformation studied by cine phase-contrast MRI. 767 39

Two cases of ganglion cysts in the lumbar spinal canal: MR findings. Ganglion cysts in the spinal canal are rare. To our knowledge, only 12 cases have been reported. In addition, ganglion cysts depicted by MR are extremely rare. We report the MR findings in two cases of ganglion cysts in the lumbar spinal canal. In both cases, the ganglion cysts were slightly higher in intensity than CSF on T2-weighted images. In addition, a thin band of low intensity was depicted around the ganglion in both cases. This finding may help to diagnose ganglion in the spinal canal. On T1-weighted images, the signal intensity of the ganglion was very similar to that of the intervertebral disc in both cases. In summary, although ganglion mimics disc hernia or sequestrated disc on both T2- and T1-weighted images, the possibility of a ganglion should be considered whenever an extradural mass showing high signal intensity surrounded by a thin band of low intensity is identified on T2-weighted images.
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PMID:Two cases of ganglion cysts in the lumbar spinal canal. 797 96


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