{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:23:27Z","timestamp":1794324207498,"version":"4.9.0"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2014,9]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>Achondroplasia may be associated with compression at the cervicomedullary junction. Determining which patients are at greatest risk for neurological complications of cervicomedullary compression can be difficult. In the current study the authors reviewed their records to determine the incidence and clinical significance of dynamic cervicomedullary stenosis and obstruction of CSF flow along with surgical outcomes following posterior fossa decompression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The authors reviewed 34 consecutive cases involving symptomatic children with achondroplasia undergoing cervicomedullary decompression performed by a single surgeon over 11 years. Of these patients, 29 had undergone preoperative dynamic MRI of the cervicomedullary junction with cine (cinema) CSF flow studies; 13 of these patients underwent postoperative dynamic MRI studies. Clinical outcomes included changes in polysomnography, head circumference percentile, and fontanel characteristics. Radiographic outcomes included changes in dynamic spinal cord diameter, improvement in CSF flow at the foramen magnum, and change in the Evans ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients were predominantly female, with a mean age at presentation of 6.6 years and mean follow-up of 3.7 years (range 1\u201310 years).<\/jats:p>\n                    <jats:p>All patients had moderate to excellent improvement in postoperative polysomnography, slight decrease in average head circumference percentile (from 46.9th percentile to 45.7th percentile), and no subjective worsening of fontanel characteristics. The Evans ratio decreased by 2%, spinal cord diameter increased an average of 3.1 mm, 5.2 mm, and 0.2 mm in the neutral, flexed, and extended positions, respectively, and CSF flow improved qualitatively in all 3 positions. There were no postoperative infections, CSF leaks, or other major complications. None of the patients undergoing initial foramen magnum decompression performed at our medical center required reoperation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with achondroplasia and symptomatic cervicomedullary compression have increased risk of dynamic stenosis at the foramen magnum evident upon dynamic cine MRI. Operative decompression may be offered with low risk of complications or need for reoperation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2014.5.peds12614","type":"journal-article","created":{"date-parts":[[2014,6,27]],"date-time":"2014-06-27T09:59:38Z","timestamp":1403863178000},"page":"238-244","source":"Crossref","is-referenced-by-count":34,"title":["Dynamic cervicomedullary cord compression and alterations in cerebrospinal fluid dynamics in children with achondroplasia: review of an 11-year surgical case series"],"prefix":"10.3171","volume":"14","author":[{"given":"Debraj","family":"Mukherjee","sequence":"first","affiliation":[{"name":"Maxine Dunitz Neurosurgical Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry D.","family":"Pressman","sequence":"additional","affiliation":[{"name":"S. Mark Taper Foundation Imaging Center,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Krakow","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Disease, Cedars-Sinai Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David L.","family":"Rimoin","sequence":"additional","affiliation":[{"name":"Medical Genetics Research Institute, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moise","family":"Danielpour","sequence":"additional","affiliation":[{"name":"Maxine Dunitz Neurosurgical Institute,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds12614","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"375","DOI":"10.3171\/jns.1990.73.3.0375","article-title":"Craniocervical decompression for cervicomedullary compression in pediatric patients with achondroplasia","volume":"73","author":"Aryanpur","year":"1990"},{"issue":"3 Suppl","key":"b2-peds12614","series-title":"J Neurosurg","first-page":"166","article-title":"Cervicomedullary decompression for foramen magnum stenosis in achondroplasia","volume":"104","author":"Bagley","year":"2006"},{"key":"b3-peds12614","series-title":"Dev Med Child Neurol","first-page":"489","article-title":"Unexpected death of children with achondroplasia after the perinatal period","volume":"24","author":"Bland","year":"1982"},{"key":"b4-peds12614","series-title":"Human Achondroplasia","first-page":"207","article-title":"Surgical management of cervicomedullary compression in achondroplastic patients","author":"Carson","year":"1988"},{"key":"b5-peds12614","series-title":"Bull Johns Hopkins Hosp","first-page":"5","article-title":"Hydrocephalus in chondrodystrophy","volume":"32","author":"Dandy","year":"1921"},{"issue":"6 Suppl","key":"b6-peds12614","series-title":"J Neurosurg","first-page":"504","article-title":"Dynamic cervicomedullary cord compression and alterations in cerebrospinal fluid dynamics in children with achondroplasia. 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