Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 50, Issue 2
Displaying 1-21 of 21 articles from this issue
Review Article
  • Bulent BAKAR
    2010 Volume 50 Issue 2 Pages 89-97
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    Primary jugular foramen meningiomas are uncommon, with 96 previous cases published between 1992 and 2007. Exact location and extent of tumor were determined on the basis of radiologic and operative findings and used to develop a staging system. The mean age of patients was 39.4 years. The lesion was located on the right in 14 patients and on the left in 11 patients. The series identified 23 males and 58 females. The most common presenting clinical symptoms were hearing loss and tinnitus. Most clinical findings were middle ear mass and neck mass. Most meningiomas were World Health Organization grade I. The most common postoperative complications were lower cranial nerve paresis and facial nerve paresis. Surgical planning should consider that meningiomas usually invade the dura mater, cranial nerves, and surrounding bone. The surgeon should carefully collect detailed data about the tumor, and consult an otolaryngologist preoperatively for lower cranial nerve functions and hearing levels.
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Original Articles
  • Atsushi SHINDO, Takehiro NAKAMURA, Yoshihito MATSUMOTO, Nobuyuki KAWAI ...
    2010 Volume 50 Issue 2 Pages 98-106
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    Embryonic stem cells (ES cells) differentiate into multiple cell lineages including neural cells. The present study optimized the method to induce differentiation of gamma-aminobutyric acid-producing neurons (GABAergic neurons) from ES cell-derived neural stem/progenitor cells (NS/PCs), and transplanted these ES cell-derived GABAergic neurons producing neural progenitors into kindled epileptic mice, and analyzed the morphological and functional recovery from epilepsy. The response of kindling was evaluated by the modified Racine scale. Following stage 5 kindling, the mice were divided into two groups. Group 1 received NS/PCs derived from the ES cells ubiquitously expressing green fluorescent protein transplanted into the dorsal hippocampal area. Group 2 received microinjections of only the medium. After transplantation, the recovery of seizures was evaluated by the modified Racine scale again. All mice were perfused and fixed for immunohistochemical analysis after finishing the kindling experiment. In Group 1, one mouse was classified as stage 0, five as stage 3, and one as stage 4 recovering from stage 5 at 6 weeks after transplantation. In Group 2, all mice remained in stage 5. The transplanted cells were examined immunohistochemically using neuronal and GABAergic markers. In the transplanted mice, substantial hippocampal GABAergic re-innervation and seizure-suppressing effects were observed. NS/PCs derived from ES cells have high potential for use in transplantation therapy for clinically intractable epilepsies.
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  • Shigeo MATSUNAGA, Takashi SHUTO, Jun SUENAGA, Shigeo INOMORI, Hideyo F ...
    2010 Volume 50 Issue 2 Pages 107-113
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    The long-term outcome of gamma knife radiosurgery (GKS) for central neurocytomas remains unclear. In the present study, we retrospectively reviewed the medical records of 7 patients with 8 central neurocytomas who underwent GKS between March 1997 and April 2007. They were 3 men and 4 women age ranging 9 to 53 years old (mean 32.5 years old). The tumor volume at the time of GKS was 0.34-6.10 cm3 (mean 3.86 cm3). All patients had undergone 1 to 3 incomplete surgical resections (mean 1.75) before GKS, the surgical specimen being evaluated histologically and immunohistochemically. The follow-up period after GKS was 15 to 136 months (mean 63.6 months). The tumors were treated with a marginal dose of 12-18 Gy (mean 13.9 Gy). Only one of the seven patients died of tumor recurrence and intracranial hemorrhage 40 months after GKS. The other tumors remained progression-free. The control rate of the tumor growth was 7/8. Although histological malignant transformation is rare, the postoperative course of this tumor is not always good, showing tumor progression, intracranial hemorrhage, or craniospinal dissemination. Therefore, we recommend GKS for residual or recurrent tumors especially at early detection before tumor progression.
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  • Ryuhei KITAI, Ken MATSUDA, Erika ADACHI, Yasushi SAITO, Tsuyoshi NAKAJ ...
    2010 Volume 50 Issue 2 Pages 114-118
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    The incidence of Epstein-Barr virus (EBV)-associated primary central nervous system (CNS) lymphoma in Japan was assessed using in situ hybridization of EBV-encoded small ribonucleic acid-1 (EBER-1) to identify the presence of EBV in 22 cases of formalin-fixed and paraffin-embedded primary CNS lymphoma. All cases were B-cell lymphoma. EBER-1 expression was observed in the nuclei of 3 of 22 primary CNS lymphoma cases (13.6%). The incidence of EBV-positive lymphoma in Japanese cases is higher than previously reported from Western countries. Patients with EBV-positive primary CNS lymphoma showed shorter survival than those with negative tumors (median 4 months vs. 26 months). EBER-1 in situ hybridization for the detection of EBV infection is rapid and reliable. Infrequent association suggests a different pathogenetic mechanism in the evolution of these tumors. Geographical differences in the incidence of EBV-associated primary CNS lymphoma may reflect epidemiological factors.
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  • Masatsune ISHIKAWA, Hisayuki OOWAKI, Atsuhito MATSUMOTO, Takayuki SUZU ...
    2010 Volume 50 Issue 2 Pages 119-123
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    Idiopathic normal pressure hydrocephalus (iNPH) is a treatable syndrome with a classical triad of symptoms. The Japanese iNPH guidelines indicate that the cerebrospinal fluid (CSF) tap test and tight high-convexity on magnetic resonance (MR) imaging are important for the diagnosis. The relationships between the effectiveness of CSF shunt surgery in possible iNPH patients, the tap test result, and the MR imaging/computed tomography (CT) findings of tight high-convexity were evaluated in 88 possible iNPH patients (mean age 75 years) with one or more of the classical triad of symptoms, and mild to moderate ventricular dilation. All patients underwent the tap test in the outpatient clinic, and patients and caregivers assessed the clinical changes during one week. The tap test was positive in 47 patients and negative in 41 patients. Surgery was performed in 19 patients with positive tap test, and was effective in 17 patients. Although the findings were inconsistent in some patients, the result of the tap test was found to be highly correlated with the MR imaging/CT finding of tight high-convexity (p < 0.0001), confirming that both these diagnostic tests are promising predictors of shunt effectiveness.
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Case Reports
  • —Case Report—
    Toshikazu KIMURA, Akio MORITA
    2010 Volume 50 Issue 2 Pages 124-126
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    A 60-year-old woman presented with a rare unruptured aneurysm of duplication of the middle cerebral artery (DMCA) identified at examination for headache. Preoperative cerebral angiography revealed the DMCA and a small aneurysm at its origin. Surgical clipping was performed successfully via the trans-sylvian approach. DMCA aneurysms have a tendency to bleed even if small, but the anatomical configuration causes some technical difficulties.
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  • —Case Report—
    Motohiro NOMURA, Hiroshi SHIMA, Takahiro SUGIHARA, Issei FUKUI, Yoshih ...
    2010 Volume 50 Issue 2 Pages 127-131
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    A 77-year-old woman presented with a rare case of nontraumatic intracavernous internal carotid artery (ICA) aneurysm causing epistaxis. The thrombosed aneurysm was discovered incidentally, and was not treated. However, she suffered massive nasal bleeding 22 months after the initial diagnosis. The lesion was successfully treated by endovascular coil embolization. The present case shows that thrombosed intracavernous ICA aneurysm may still carry the risk of rupture. Radiological evidence of erosion of the sphenoid sinus wall and repeated minor bleeding may be important predicting signs for massive nasal bleeding. Parent artery occlusion including the aneurysm may be the best treatment for intracavernous ICA aneurysms if sufficient collateral blood flow to the territory of the affected ICA is expected.
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  • —Case Report—
    Hironaga KAMIYAMA, Shinjitsu NISHIMURA, Mitsuhiro KAIMORI, Mika WATANA ...
    2010 Volume 50 Issue 2 Pages 131-134
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    A 61-year-old man presented a rare case of cerebral cavernous angioma associated with cerebral arteriovenous malformation (AVM) manifesting as headache. Magnetic resonance imaging showed an AVM in the right occipital lobe and a cavernous angioma in the left middle fossa. The patient underwent left frontotemporal craniotomy with total resection of the left parasellar intra-axial tumor. One month after the first operation, he underwent right occipital craniotomy with total resection of the right occipital AVM. The histological diagnoses were cavernous angioma and AVM, respectively. Immunostaining for angiogenic growth factors and structural proteins revealed different expression patterns of alpha-smooth muscle actin in these structures. Expression of structural proteins may reflect differences in their pathogenesis.
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  • —Case Report—
    Yoshiro ITO, Yuji MATSUMARU, Kensuke SUZUKI, Akira MATSUMURA
    2010 Volume 50 Issue 2 Pages 135-138
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    A 69-year-old female presented with multiple cerebellar infarctions and mild cognitive dysfunction. Cerebral angiography revealed severe right vertebral artery (VA) stenosis just proximal to the origin of the posterior inferior cerebellar artery. Neuropsychology tests showed the mini-mental state examination (MMSE) score was 21, and the Wechsler Adult Intelligence Scale-Revised (WAIS-R) score was 70. Cerebrovascular reactivity (CVR) was decreased in the bilateral cerebral and cerebellar hemispheres. Stent-assisted angioplasty of the right VA was performed to prevent recurrence of the cerebellar infarction. Post-procedure, the neuropsychology tests showed cognitive improvement to MMSE score of 26 and WAIS-R score of 84. CVR had also improved in the bilateral cerebral hemispheres. Cerebellar hypoperfusion due to VA stenosis had probably caused functional depression of the cerebello-cerebral pathway, a condition referred to as crossed cerebello-cerebral diaschisis. In this case, cognitive dysfunction was reversed due to recovery of the cerebello-cerebral pathway.
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  • —Case Report—
    Yuzo TERAKAWA, Takashi TSURUNO, Kenichi ISHIBASHI, Yumiko OKADA, Katsu ...
    2010 Volume 50 Issue 2 Pages 139-143
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    A 21-year-old man presented with a hemorrhagic central neurocytoma manifesting as acute onset of disturbance of consciousness and right hemiparesis. Computed tomography (CT) demonstrated a tumor in the left lateral ventricle during the course of evaluation for mental alteration 12 days before onset, but the tumor was left untreated because the patient refused to visit a neurosurgical institution. CT on admission revealed a large mass lesion located in the body of the lateral ventricle associated with massive intratumoral and intraventricular hemorrhage. He underwent emergent surgery for evacuation of the tumor with hematoma, and his neurological symptoms gradually recovered after surgery. The present case highlights the possibility of rapid deterioration of symptoms by massive hemorrhage from central neurocytoma. Surgical intervention should thoroughly be considered, if intratumoral hemorrhage is present, as hemorrhage from the central neurocytoma may lead to serious neurological complications.
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  • —Case Report—
    Tetsuro SAMESHIMA, Rokuya TANIKAWA, Toshihide SUGIMURA, Naoto IZUMI, T ...
    2010 Volume 50 Issue 2 Pages 144-146
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    A 51-year-old female presented with a rare case of choroid plexus papilloma originating in the sella turcica manifesting as headaches that was not readily distinguishable preoperatively from pituitary adenoma. Head magnetic resonance imaging revealed a tumor extending from the sella turcica to the suprasellar cistern. The tumor was removed via an endonasal transsphenoidal approach. Histological examination indicated a papillary structure covered with a layer of columnar epithelial cells that resembled normal choroid plexus. These findings, together with immunohistochemistry, led to a diagnosis of choroid plexus papilloma.
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  • —Case Report—
    Tetsuro SAMESHIMA, Rokuya TANIKAWA, Toshihide SUGIMURA, Naoto IZUMI, T ...
    2010 Volume 50 Issue 2 Pages 147-149
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    An 18-year-old male presented with a chondroma in the petrous apex manifesting as major complaints of headaches and sensorineural hearing disturbance on the right. Head computed tomography and magnetic resonance imaging revealed a neoplastic lesion in the right petrous apex, which had bulged to compress the internal auditory meatus. Surgical removal improved his hearing with normalization of the postoperative air conduction threshold by reduction of the pressure of the internal auditory meatus, suggesting that the function of the cochlea was retained and the tumor was compressing the cochleal nerve at the level of the internal auditory meatus. Histological examination showed the tumor consisted of hyaline cartilage tissue without cellular atypia and the diagnosis was chondroma.
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  • —Case Report—
    Eika HAMANO, Satoshi TSUTSUMI, Yasuomi NONAKA, Yusuke ABE, Yukimasa YA ...
    2010 Volume 50 Issue 2 Pages 150-153
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    A 15-year-old boy presented with an anaplastic supratentorial ependymoma causing massive intratumoral calcification, without contributory medical and family history, and manifesting as persistent headache for 2 months. Physical examination found no neurological deficit except for visual defect in the right lower quadrant, with intact visual acuity. Blood examination showed no abnormalities. Cranial computed tomography revealed a huge calcified mass in the left parietooccipital lobe, with extensive perilesional brain edema. Cranial radiography showed diffuse and symmetrical thinning of the calvarial bone. Magnetic resonance imaging confirmed the tumor as an assembly of medullated masses with extraventricular location, 7 × 6.5 × 6.5 cm in diameter, and appearing as heterogeneous intensity on both T1- and T2-weighted images with inhomogeneous enhancement except for the central cores. The patient underwent tumor resection. Intraoperative findings revealed that the cortical veins overlying the tumor were reddish and moderately engorged. The hypervascular tumor, entirely extraventricular in location, was totally resected without neurological deterioration. Histological examination revealed that the tumor was highly cellular with hyperchromatic nuclei and cell atypia. Necrosis, mitotic figures, and perivascular pseudorosette formations were frequently seen. Immunohistochemical study showed positive staining for glial fibrillary acidic protein, S-100 protein, vimentin, and epithelial membrane antigen, but negative for synaptophysin. The MIB-1 labeling index was 26.5%. The findings were compatible with anaplastic ependymoma (World Health Organization classification grade 3). Ependymoma should be included in the differential diagnosis of a supratentorially located, extraventricular mass with massive intratumoral calcification.
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  • —Case Report—
    Yasuo HIRONAKA, Hiroyuki NAKASE, Yasushi MOTOYAMA, Hideaki MISHIMA, Yo ...
    2010 Volume 50 Issue 2 Pages 154-157
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    A 58-year-old man presented with a rare orbitocavernous sinus schwannoma that originated from the orbital opthalmic nerve, and manifested as slowly progressive hypesthesia of the right side of the forehead, proptosis, and ocular pain with rapidly worsening visual acuity. Magnetic resonance imaging revealed a huge orbital tumor extending to the lateral wall of the cavernous sinus through the superior orbital fissure. Microsurgical total resection of the tumor was achieved using an epidural orbitofrontal approach with orbito-fronto-zygomatic craniotomy. The histological diagnosis was schwannoma with Antoni type A formation. The postoperative course was uneventful except for the hypesthesia on the right side of the forehead and transient oculomotor paralysis. Surgery was effective to relieve the symptoms and improve the activities of daily living.
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  • —Case Report—
    Atsushi ARAI, Akitsugu MORISHITA, Yusei HANADA, Hideo AIHARA
    2010 Volume 50 Issue 2 Pages 158-161
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    A 61-year-old female, previously treated for lung cancer, presented with a rare case of metastasis directly to the optic chiasm manifesting as visual deficits. Magnetic resonance imaging revealed a suprasellar mass similar to an optic glioma. At surgery, the optic chiasm appeared swollen with hypervascularity over the surface. The bilateral optic nerves and the pituitary stalk appeared normal. A small incision was made on the superior surface of the chiasm and biopsy specimens were taken. The histological diagnosis was adenocarcinoma, which was consistent with the primary lung cancer. She received whole brain irradiation, resulting in mild improvement of her vision. Suprasellar metastatic tumors to the pituitary gland, pituitary stalk, and hypothalamus are well documented, but solitary metastasis within the optic chiasm should be considered as one of several differential diagnoses of suprasellar tumors, in patients with or without a history of treated cancer.
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  • —Case Report—
    Nobuo NOSHITA, Shoji MASHIYAMA, Osamu FUKAWA, Shigeyuki ASANO, Mika WA ...
    2010 Volume 50 Issue 2 Pages 161-164
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    We report a rare case of anaplastic oligodendroglioma with extracranial metastasis, showing 1p19q co-deletion in both the brain tissue and the metastatic site. A 53-year-old man first presented with a left frontal tumor. The tumor was subtotally removed and irradiation was performed for the residual tumor and tumor bed. Two years after the initial treatment, several tumors appeared on his neck and one was resected. Histological examination revealed anaplastic oligodendroglioma, proved to be the same as the previous brain tumor. The patient refused further treatment, and died 30 months after the initial treatment. Autopsy demonstrated multiple extracranial metastases in the vertebrae, lymph nodes, spinal dura mater, thymus gland, and chest wall. We confirmed 1p19q loss of heterozygosity in both lesions, suggesting that 1p19q co-deletion might important to extracranial metastasis of oligodendroglioma.
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  • —Case Report—
    Takeshi AOYAMA, Kazutoshi HIDA
    2010 Volume 50 Issue 2 Pages 165-167
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    A 69-year-old man presented with subarachnoid hemorrhage due to a ruptured anterior communicating artery aneurysm. The aneurysm neck was clipped and a lumbar drainage tube was inserted for cerebrospinal fluid drainage. However, the tube was accidentally cut during removal and a fragment remained in the spinal canal. A subarachnoid, subcutaneous abscess appeared 7 days later, which was treated with antibiotics. He noted numbness of his left leg after 6 months, and gait disturbance manifested 3 months later. T1-weighted magnetic resonance (MR) imaging disclosed a well-enhanced extramedullary mass at the T9-10 intervertebral level, and T2-weighted MR imaging showed moderate edema around the peri-lesional spinal cord. The mass containing a drainage tube fragment was surgically removed. Histological examination confirmed granuloma due to chronic infection. This case suggests that retained tube fragments should be removed surgically, especially in the presence of infectious complications.
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  • —Case Report—
    Satoshi NAKAMURA, Takakazu KAWAMATA, Tomonori KOBAYASHI, Tomokatsu HOR ...
    2010 Volume 50 Issue 2 Pages 168-171
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    A 64-year-old woman presented with a very rare case of three infectious lesions, cavernous sinus thrombophlebitis, clival inflammation, and orbital subperiosteal abscess (SPA), manifesting as abducens palsy. An isolated non-specific mass in upper clivus was initially suspected to be derived from paranasal sinusitis. The clival lesion was approached by an endonasal transsphenoidal route and diagnosed as inflammation. However, progressive enlargement of an orbital mass was recognized, with eyelid erythema and swelling. Magnetic resonance imaging showed massive paranasal sinusitis and an intra-orbital mass, which was proved to be an orbital SPA by open surgery. Cavernous sinus thrombophlebitis might have been caused by primary paranasal sinusitis, and the origin of orbital cellulitis was suspected to be cavernous sinusitis based on the preoperative radiological findings. These unusual lesions should be kept in mind as one of the differential diagnoses.
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  • —Case Report—
    Naoki KATO, Toshihide TANAKA, Hiroyasu NAGASHIMA, Takao ARAI, Yuzuru H ...
    2010 Volume 50 Issue 2 Pages 172-174
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    A 50-year-old woman presented with nuchal pain, clumsiness in both hands, and gait disturbance. Cervical magnetic resonance (MR) imaging showed cervical canal stenosis at C3-C7 levels associated with a syrinx and cerebellar tonsillar herniation. The patient underwent C3-C7 laminoplasty. Her symptoms improved completely, and the patient was discharged 10 days after operation. Postoperative MR imaging showed disappearance of the syrinx. This case suggests that cerebellar tonsillar herniation may not cause syringomyelia. Posterior decompression, such as laminectomy and laminoplasty, without foramen magnum decompression may be an appropriate surgical strategy for diffuse cervical canal stenosis associated with syringomyelia below the narrow canal, even in the presence of co-existing Chiari malformation.
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  • —Case Report—
    Hidenobu OCHIAI, Hirokazu KAWANO, Ryo MIYAOKA, Rie NAGANO, Keiichiro K ...
    2010 Volume 50 Issue 2 Pages 174-177
    Published: 2010
    Released on J-STAGE: February 25, 2010
    JOURNAL OPEN ACCESS
    An infant presented with a rare cervical (non-terminal) myelocystocele as a congenital skin-covered mass located in the midline of the posterior aspect of her neck. Magnetic resonance (MR) imaging and computed tomography showed a cystic mass filled with cerebrospinal fluid in the midline of the posterior aspect of the neck, with a fibrous streak extending from the bottom of the sac to the dorsal surface of the cervical cord. Brain MR imaging also showed a dilated ventricular system and Chiari type II malformation. The patient underwent plastic repair of the lesion, which was diagnosed as myelocystocele. After the surgery, the patient experienced respiratory distress. Ultrasound tomography from the anterior fontanel revealed deterioration of hydrocephalus, so a ventriculoperitoneal shunt was inserted, and the respiratory distress improved. The present case illustrates the possibility of rapidly worsening of hydrocephalus and Chari type II malformation after surgical repair of cervical (non-terminal) myelocystocele.
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