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The use of the trendelenburg position in the surgical treatment of extreme cerebellar slump

Frank Dewaele (UGent) , Alain Kalmar (UGent) , Edward Baert (UGent) , Annemieke Van Haver (UGent) , Giorgio Hallaert (UGent) , Frank De Mets (UGent) , Leonie Williams, Jean-Pierre Kalala Okito (UGent) , Koen Paemeleire (UGent) , Jacques Caemaert (UGent) , et al.
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Abstract
Background. State-of-the-art treatment for Chiari Malformation I (CM-I) consists of decompression by posterior fossa craniectomy. A rare but severe complication that develops over months to years after this procedure is cerebellar slump. Treatment options for this condition are limited. We present a new and promising approach to treat this rare condition. Methods. The patients were placed in the Trendelenburg position to facilitate ascent of the cerebellum. After almost complete dissolution of neurologic symptoms, surgical reconstruction was performed by tonsillar resection and the creation of a new structural support using a bone graft. Results. Both patients experienced good clinical and morphological outcomes immediately after surgery, and for two years thereafter. Conclusions. Neurological symptoms related to cerebellar or brainstem slump can be adequately reversed by placing the patient in the Trendelenburg position. After uneventful gravitational reversal of the slump, safe surgical reconstruction of the cerebellar support can be performed to securely preserve the anatomical reversal.
Keywords
slump, cerebellar, brainstem, Trendelenburg, SURGERY, HINDBRAIN, MANAGEMENT, SYRINGOMYELIA, CRANIOCERVICAL DECOMPRESSION, EXPANSIVE SUBOCCIPITAL CRANIOPLASTY, FORAMEN MAGNUM DECOMPRESSION, CHIARI-I MALFORMATION

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Chicago
Dewaele, Frank, Alain Kalmar, Edward Baert, Annemieke Van Haver, Giorgio Hallaert, Frank De Mets, Leonie Williams, et al. 2016. “The Use of the Trendelenburg Position in the Surgical Treatment of Extreme Cerebellar Slump.” British Journal of Neurosurgery 30 (1): 115–119.
APA
Dewaele, Frank, Kalmar, A., Baert, E., Van Haver, A., Hallaert, G., De Mets, F., Williams, L., et al. (2016). The use of the trendelenburg position in the surgical treatment of extreme cerebellar slump. BRITISH JOURNAL OF NEUROSURGERY, 30(1), 115–119.
Vancouver
1.
Dewaele F, Kalmar A, Baert E, Van Haver A, Hallaert G, De Mets F, et al. The use of the trendelenburg position in the surgical treatment of extreme cerebellar slump. BRITISH JOURNAL OF NEUROSURGERY. 2016;30(1):115–9.
MLA
Dewaele, Frank, Alain Kalmar, Edward Baert, et al. “The Use of the Trendelenburg Position in the Surgical Treatment of Extreme Cerebellar Slump.” BRITISH JOURNAL OF NEUROSURGERY 30.1 (2016): 115–119. Print.
@article{6959559,
  abstract     = {Background. State-of-the-art treatment for Chiari Malformation I (CM-I) consists of decompression by posterior fossa craniectomy. A rare but severe complication that develops over months to years after this procedure is cerebellar slump. Treatment options for this condition are limited. We present a new and promising approach to treat this rare condition. Methods. The patients were placed in the Trendelenburg position to facilitate ascent of the cerebellum. After almost complete dissolution of neurologic symptoms, surgical reconstruction was performed by tonsillar resection and the creation of a new structural support using a bone graft. Results. Both patients experienced good clinical and morphological outcomes immediately after surgery, and for two years thereafter. Conclusions. Neurological symptoms related to cerebellar or brainstem slump can be adequately reversed by placing the patient in the Trendelenburg position. After uneventful gravitational reversal of the slump, safe surgical reconstruction of the cerebellar support can be performed to securely preserve the anatomical reversal.},
  author       = {Dewaele, Frank and Kalmar, Alain and Baert, Edward and Van Haver, Annemieke and Hallaert, Giorgio and De Mets, Frank and Williams, Leonie and Kalala Okito, Jean-Pierre and Paemeleire, Koen and Caemaert, Jacques and Van Roost, Dirk},
  issn         = {0268-8697},
  journal      = {BRITISH JOURNAL OF NEUROSURGERY},
  keywords     = {slump,cerebellar,brainstem,Trendelenburg,SURGERY,HINDBRAIN,MANAGEMENT,SYRINGOMYELIA,CRANIOCERVICAL DECOMPRESSION,EXPANSIVE SUBOCCIPITAL CRANIOPLASTY,FORAMEN MAGNUM DECOMPRESSION,CHIARI-I MALFORMATION},
  language     = {eng},
  number       = {1},
  pages        = {115--119},
  title        = {The use of the trendelenburg position in the surgical treatment of extreme cerebellar slump},
  url          = {http://dx.doi.org/10.3109/02688697.2015.1073220},
  volume       = {30},
  year         = {2016},
}

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