KASSANOS teliko

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1 01. ﾒ 閨0309, 04. ﾒ ｹ0, 6ﾑ8. 6ｾ 閨02090ｹ0. 罍ｯ ｸ ｧ 縺0ｸ ｧ8 ﾒ ｧ apple ｧ9080ｸ7 ﾞ , ﾞ6ﾒ26ﾒ2ｦﾐ ﾒ ﾌ ｹ ｸ7 08apple ｧ9080ｸ7 6 5fi ｸ7 ｨCDandy Walker 046ｦ ﾞ ｧ9 : 066ｧ , ｸ ﾒ20903.: , 00040ｷ [email protected] ﾒ 閨 ｧ ｧ To 046ｦ Dandy Walker apple 03080ｸ ｨB : 1) 06 08fi03080ｸ ｦ ｷ ｸ ｸ7, 2) 閨 ｧ ) 閨 ｹ0 apple ｧ9 080ｹ ｷ ｸ7 08apple086ｧ9080ｸ ｧ8 00apple ｷ307006ｧ 閨 ｧ ｸ7036ｦ ｷ ｸ7 08apple6ｧ ｸ7 6 5fi ｸ7 閨 apple ｧ9 040ｷ3036ｧ90ｹ0 07 0ｸ7apple ｸ ｧ ｧ ｹ ｦ ｸ70ｹ0: 1) ｧ8 Dandy Walker 070ｷ ｧ9 apple080ｸ7 040ｸ7076ｧ ｸ7 08apple6ｧ ｸ7 6 5fi ｸ7, apple036ｧ ｧ ｧ ｧ ｸ ｹ0 apple ｧ9 0ｹ ｸ76 70ｷ300 閨 ｧ9 0608, 2) 09 apple ｧ ｸ7 Dandy Walker apple080ｸ ｧ9ｨB0006 apple ｧ ｸ7apple08apple03 046ｧ ｸ ｹ0 apple ｧ9 0ｹ ｧ8 040ｷ3036ｧ90ｹ ｸ7 08apple6ｧ ｸ7 6 5fi ｸ7), 3) 閨 ｧ 閨 閨 ｧ9. 6ﾑ8apple6ｧ904090ｹ0 閨 apple ｧ ｧ80ｹ ｧ ｸ ｹ0 apple ｧ9 0ｹ0, ｦ Joubert apple080ｸ7 040ｸ ｦ applefi 00apple000604fi 06 0ｸ7apple apple076ｧ9 0ｹ0, apple 閨0ｹ ｧ ｹ0 020ｷ ｧ ｧ8 0ｸ70402 閨 ｷ3036ｧ90ｹ 閨0ｹ fi ｦ Joubert apple ｧ ｧ9 applefi ｷ300 閨0709 Dandy Walker ｧ8. ﾇ 070ｷ ｧ9 Arnold Chiari 006ｧ apple6ｧ904090ｹ ｸ7 08apple ｧ9080ｸ ｸ apple ｧ applefi 6ｦ 閨 ﾒ208 apple ｧ fi03080ｸ ｦ fiapple ｦ0 apple080ｸ7 apple0308 閨 applefi ｧ ｸ ｹ0 apple ｧ9 0ｹ apple0807 0ｸ fi 0ｸ7-69

2 ｹ ｸ7 08apple ｧ9080ｸ7 6 5fi ｸ7 ｨCDandy Walker 046ｦ ﾒ 閨 ｸ fi. 6ﾒ ｦ ｧ ｧ9 fi ｸ703 6ｧ fiapple ｹ0 09 閨080ｸ703 0ｹ0, 02090ｹ0 02 閨 ｹ ｧ9 0ｹ ｸ7 apple ｧ ｸ ｦ 閨04080ｸ ｸ ｦ ｧ ｹ apple0807 0ｸ fi 0ｸ703fi. 6ｾ40ｸ7076ｧ8030ｷ30ｹ0 040ｸ ｦ ｸ 閨 ｸ ｧ 閨 ｹ : 046ｦ Dandy Walker, 070ｷ ｧ9000ｹ apple ｹ ｸ , ｹ ｹ ｧ9 0ｹ0 6ﾑ ｷ3096ｧ8 ｨC ﾞ ｧ9 6ﾒ ｦ Dandy Walker apple ｷ apple086ｧ9000ｹ ｧ apple ｧ8 0707apple020ｸ ｹ0 apple ｧ9-0ｹ0. 6ﾒ ｦ ｸ702fi 006ｧ apple ｧ9 閨 apple080ｸ7 apple ｦ0apple02080ｸ707 applefi ｸ7apple08apple03 046ｧ ｹ0 apple ｧ9 0ｹ ｸ70708 fi ｧ8 0707apple020ｸ ｹ0 02 閨 ｹ ｧ9 0ｹ0. ﾒ0ｸ7036ｧ ｦ ｧ ｹ0 02 閨 ｹ ｧ9 0ｹ ｸ ｸ7,09 08apple086ｧ fi0408 apple08036ｦ ｧ apple6ｧ fi ｾ40ｸ707 0ｸ707ｨB fi03080ｸ ｦ ｷ307 apple03 096ｧ90ｷ 閨 ｧ 閨 ｸ ｹ0 apple ｧ9 0ｹ0 00 閨040ｷ ｸ7 08apple086ｧ9080ｸ ｧ8 00apple ｷ307006ｧ 閨 ｧ9. 1 6ﾒ ｸ702 6ｧ9 0403fi ｧ9 閨04080ｸ707 apple ｧ ｸ ｷ ｷ ｸ7 08apple6ｧ ｸ7 6 5fi ｸ7 apple080ｸ ｨB080ｸ fi 046ｦ Dandy Walker. ﾌ06 apple fi ｧ9 apple ｸ fi03080ｸ ｸ7036ｧ : 1) 020ｸ ｧ ｹ0 02 閨 ｹ ｧ9 0ｹ0,2) 0ｸ ｧ ｸ ｹ0 apple ｧ9 0ｹ ) 0ｸ ｧ8 03 閨 ｸ ｧ9080ｸ7. 6ﾑ8apple6ｧ ｸ7 apple 03fi ｹ0, 08 fi03080ｹ0 Dandy Walker apple ｧ ｧ 閨 ｷ ｸ7 08apple6ｧ ｸ7 6 5fi ｸ apple086ｧ9000ｹ ｦ applefi ｧ8 0ｸ7apple ｧ ｧ9 (CT scans) 0ｷ30ｹ ｦ0-030ｷ30ｹ0: 1) ｧ8 Dandy Walker 070ｷ ｧ9, ( ｸ7 08apple6ｧ ｸ7 6 5fi ｸ7, apple036ｧ803090ｹ0 6ｧ ｧ ｧ ｸ ｹ0 apple ｧ9 0ｹ0, 070ｸ76 70ｷ300 閨 ｧ9 0608) 2) apple ｧ ｸ7 Dandy Walker (apple ｧ ｸ7apple08apple03 046ｧ ｸ ｹ0 apple ｧ9 0ｹ ｧ8 040ｷ3036ｧ90ｹ ｸ7 08apple6ｧ ｸ7 6 5fi ｸ7) ) 閨 ｧ 閨 閨 ｧ9 (mega-cisterna magna). 2 ﾞ ｸ 閨 ｹ0 閨 ｷ ｧ9 fi ｧ 閨07 080ｸ fi ｷ fi ｧ ｦ Dandy Walker, apple0608 apple03fi ｹ 閨02000ｹ 閨03080ｸ707 fi fi 046ｦ ｷ ｧ apple030ｷ fi 006ｦ 閨 ｸ70ｹ0 apple fi ｸ70ｹ ｧ90ｹ apple026ｦ ｸ ｸ70ｹ0 apple ｸ70ｹ0 006ｧ807000ｹ ｹ0 ｨB0ｷ36ｧ80ｹ0. 3 ﾇ 070ｷ ｧ9 Dandy Walker ｧ9ｨB ｸ70407fi / ｧ ｹ ｸ7036ｧ % 閨0ｷ30ｹ0 12% fi030ｷ ｷ307 apple000306apple ｷ ｦ0 0ｸ 閨 ｸ7. ﾇ 040ｸ70407fi ｷ307 apple ｸ7 040ｸ707 03fi00080ｸ ｹ ｹ ｹ ｧ80ｹ0 006ｧ ｷ ｷ3-036ｧ9000ｹ apple 閨 apple ｸ ｧ9 020ｷ ｷ307 Luschka Magendie ｸ apple ｧ9 07 apple 03080ｸ ｨB080ｸ apple fi ｧ ｸ7apple ｸ7apple08apple03 046ｧ apple ｸ ｦ0 apple ｧ8 0707apple020ｸ ｹ0 apple ｧ9 0ｹ ｧ fi ｧ9 0ｸ7026ｧ80ｹ ｹ ｹ0 apple 6ｧ9ｨB080ｸ fi 03fi ｧ9 apple ｹ0. ﾇ 070ｷ ｧ9 Dandy Walker 00apple ｧ ｧ 閨0ｹ 閨0ｹ ｷ ｷ 閨0ｹ ｹ0 6ﾑ apple ｧ9 00 閨03080ｹ ｷ 閨07080ｸ7 040ｸ707 03fi00080ｸ7, ｧ907 0ｸ707080ｹ0 00apple ｹ0 006ｧ % 閨0ｷ30ｹ0 5%.6ｾ400 04apple ｹ0 apple000306apple ｹ 閨 ｧ ｸ ｷ fi 0ｸ7apple applefi fiapple ｧ9 apple ｹ0, 閨0ｹ0 applefi 06086ｦ00ｹ0, 036ｧ fi ｧ802090ｹ ｹ 閨03 0ｹ0 閨04080ｸ apple ｧ ｸ7 040ｸ707 03fi00080ｸ7. ﾇ fi ｸ7 040ｸ707 03fi00080ｸ7 閨 ｦ ｧ ｸ7 MRI. 縺 fi03080ｸ70ｹ0 03fi09080ｸ70ｹ apple ｹ 閨0ｹ0 apple080ｸ7 apple apple ｦ CT 0007 閨04080ｸ fi ｧ804080ｸ ｧ 閨 ｹ ｸ ｹ0 apple ｧ9 0ｹ apple ｦ ｸ7apple ｧ804080ｸ707 6ｧ8 07 0ｸ7apple ｧ804080ｸ 閨 ｹ0 0007fi0ｹ ｧ ｹ0. ﾇ ｧ ｸ ｷ307 00apple06006ｧ8020ｷ307 00apple06apple - 70

3 0ｷ307 apple080ｸ7 00apple ｦ MRI apple 陦 fi fi apple080ｸ7 閨 CT 6ｧ apple 03026ｧ80ｹ0 07 apple ｧ ｧ ｸ7 040ｸ707 03fi00080ｸ7 Dandy Walker. ﾒ07- apple ｧ9 0ｸ ｧ9 0ｹ ｸ apple ｦ ｸ ｦ fi03000ｹ ｹ0 apple000306apple ｹ0, 02fi fi ｸ7apple ｹ ｹ ｧ80ｹ0, ｧ ｧ apple 閨0ｹ ｸ7 040ｸ707 03fi00080ｸ7 閨04080ｸ707 02fi ｹ fi ｹ0 apple080ｸ7 閨07 0ｹ ｧ80ｹ ｷ fi0ｹ0 00apple ｧ ｧ ｦ ｹ0. To 046ｦ ｸ702fi 00apple ｧ ｸ ｦ ｸ ｹ ｹ ｸ ｸ ｦ0 6ｾ40ｸ ｧ ｹ0 020ｸ7036ｧ90ｷ30ｹ ｷ , ｹ ｹ0 00 閨04090ｹ ｧ80ｹ0, fiapple0ｷ30ｹ ｧ ｸ ｧ9080ｸ7, apple ｧ ｧ803000ｹ0. 6ｾ 閨0ｹ0 apple000306apple ｹ0 閨 apple ｧ9 09 apple 03080ｸ7046ｧ9 apple08030ｸ ｸ7036ｧ9 0ｹ0, 070ｷ ｸ7 080ｸ70308apple ｦ0 040ｸ704026ｧ ｹ0, 閨0ｹ0 070ｷ ｧ9000ｹ ｧ9000ｹ ｸ7 apple apple080ｸ 閨02000ｹ 閨 ｧ9ｨB080ｸ ｸ70407fi ｸ ｷ apple080ｸ7 020ｸ700 6ｧ ｦ0 50% %. 08apple ｧ9 ﾇ 0ｸ7apple ｧ ｷ ｸ ｦ0 Dandy Walker 006ｧ ｸ ｧ8 040ｸ7076ｧ8030ｷ30ｹ0 applefi ｧ ｹ ｸ ｦ007090ｹ07 fi000ｷ30ｹ0 閨 ｧ applefi ｹ0 026ｦ ｹ apple ｹ apple06026ｧ8 0ｸ7apple ｧ9. 8 6ﾑ80602fi07 1: 6ｾ46ｦ Dandy Walker apple ｧ apple ｧ ｸ7apple ｧ ｧ8 6ﾑ80602fi07 2: ﾞ09 閨 ｸ ｸ ｧ9 6ｾ400 0ｸ7apple ｧ ｧ8, apple080ｸ7 08 6ｧ apple ｧ9, 0ｸ7apple apple ｧ 閨 apple6ｧ ｧ8 apple080ｸ7 00apple ｷ307006ｧ apple ｧ ｹ0 02 閨 ｹ ｧ9 0ｹ0 00 閨040ｷ ｧ ｹ ｸ7 apple ｦ (6ﾑ80602fi07 1) 6ｾ40ｸ apple ｧ ｸ ｦ ｧ8 00 閨 閨 ｧ ｹ ｹ0 applefi fi 07000ｸ fi 046ｦ ｹ ｸ70708 閨0ｹ 閨0ｹ0 applefi ｸ704026ｧ ﾑ ｦ ｹ apple000306apple ｹ ｧ ｧ ｸ ｸ ｧ800, ｧ ｧ8 apple080ｸ7 apple apple ｧ9 00apple ｧ ｧ ｷ ｧ apple ｧ9 00apple6ｧ ｦ apple ｷ303006ｧ 閨 ｨB ｧ8 閨 ｹ ｧ fi ｧ apple ｧ9 fi ｧ ｸ ｷ3036ｧ9ｨB 閨 ｧ9 applefi ｧ apple ｧ9 閨 ｸ7026ｧ ﾒ ｧ ｧ ｷ ｹ 閨07090ｹ ｹ ｧ80ｹ ｷ307 apple Dandy Walker 0007 閨04080ｸ707 0ｸ ｧ9 00 閨 ﾒ 閨 ｧ8 apple03 鐶pple ｸ7apple08apple02000ｸ7fi fi ｹ ｹ ｹ ｧ80ｹ0 006ｧ ｦ applefi10mm, apple ｧ ｸ7 040ｸ707 03fi00080ｸ7 fi ｧ ｧ8 00apple ｷ3076ｧ ｧ ｦ ｹ0 02 閨 ｹ ｧ9 0ｹ ｹ ｹ ｧ80ｹ0. 6ｾ402060ｹ 閨0ｹ ｸ7 2080ｸ ｧ807080ｸ7 09 0ｸ7apple ｧ ｸ ｧ80ｹ0 0707apple020ｸ701090ｹ ｹ0 71

4 ｹ ｸ7 08apple ｧ9080ｸ7 6 5fi ｸ7 ｨCDandy Walker 046ｦ ﾒ 閨 ｸ707. apple ｧ9 0ｹ0 00apple ｧ apple ｦ fi0408. ﾇ 閨 ｧ apple 03026ｧ80ｹ fi0ｹ ｸ apple ｧ ｸ 閨 ｦ0apple0ｷ ｸ ｧ ｹ ﾑ86ｧ apple0800 閨070ｷ30ｹ0 apple ｧ90ｹ ｷ ｹ0 閨 ｹ ｸ ｸ7026ｧ ｧ9 026ｦ ｹ0. 6ｾ40ｸ apple ｸ7 0ｸ7apple ｧ ｹ ｹ ｹ0 6ｧ fi ﾞ02fi ｧ ｧ ｧ ｧ ｧ ｹ0 090ｷ3076ｧ9 0ｹ ｷ304090ｹ0 00apple ｧ ｦ0- apple0ｷ ｹ0 6ｦ ｹ ｸ 閨03080ｸ70ｹ ｹ ｹ ｧ80ｹ0, ｧ ｹ ｸ ﾇ 03046ｧ ｸ ｦ0 0ｸ702086ｦ ｹ0 006ｧ ｧ80ｹ ｸ7apple ｧ9 fi apple ｧ ｸ ｧ9 applefi apple 03080ｸ7046ｧ9 0ｸ ｦ ｹ0 6ｦ ｹ ｹ0 apple ｧ9 0ｹ0 apple080ｸ ｧ apple ｧ9 apple03080ｹ apple03fi0ｹ ｦ0apple applefi 閨 apple02fi ｹ ｸ apple086ｧ apple ｧ ｧ apple02fi 閨 ｸ ｹ fi07 0ｹ0 applefi ｸ7apple fi apple fi. ﾇ apple ｧ 閨 ｷ307 0ｸ ｷ ｹ0 apple ｧ9 0ｹ0, ｸ ｧ ｦ0apple0ｷ ｹ0 00apple ｷ3076ｧ9 0ｹ ｦ ｹ0 02 閨 ｹ ｧ9 0ｹ ｹ ｹ ｧ80ｹ0, fi ｸ7026ｧ8 apple080ｸ7 apple CT 閨02000ｹ ｹ0 apple ｧ80ｹ ｸ7 040ｸ707 03fi ｸ7 Dandy Walker. ﾇ 00apple060402fiapple ｸ7 08apple ｧ9080ｸ7 6 5fi ｸ 閨 apple6ｧ9apple apple ｧ ｧ ｸ702 閨0ｹ ｹ0 apple000306apple ｹ0 0008fi apple 鐶pple apple060402fiapple ｸ ｹ0 apple ｧ9 0ｹ ｧ908 00apple6ｧ9apple ﾞ02fi ｸ7026ｧ8 09 apple 閨 apple ｧ apple 閨 ｧ8 02 0ｸ70208apple086ｧ ｹ0 0ｸ ｧ9 0ｹ ｹ0 apple ｧ9 0ｹ 閨07, ｸ7apple 閨 apple 鐶pple ｷ fi apple ｸ7 Dandy Walker 0ｸ702 閨0ｹ0 apple ｸ 閨 ｧ 閨07 000ｸ7036ｦ0 閨 ｸ7 apple ｦ ｧ9ｨB ｧ ｧ8 Dandy Walker. ﾇ 0000apple ｧ9 006ｧ apple 閨 fi ｧ90ｹ0 apple 閨0ｹ0. 6ﾑ86ｧ ｸ ｦ ｷ ｧ fi apple03fi 閨 ｧ8 6ｧ8 閨 fi 閨 ﾇ ｧ ｧ8 Dandy Walker apple fi ｹ0 ｨB0ｷ36ｧ80ｹ0, ｸ700apple ｸ ｸ7 6ｧ ｷ ｸ ｧ90ｷ ｧ9 0ｸ ｧ fi 閨0ｷ30ｹ0 24% ｹ0 apple ｹ ｸ ｸ 閨0ｹ 閨02000ｹ0, fi090ｷ3 020ｷ ｧ901000ｷ apple ｧ ｧ ｹ ｸ 閨0ｹ 閨0ｹ ｹ0 閨04080ｸ ｧ fi ﾇ apple07000ｸ ｧ8 0707apple020ｸ ｸ70ｹ0 00apple06ｨB6ｧ ｹ0 006ｧ fi 閨07090ｹ ｹ0 04apple 0706fi ｹ ｹ ｹ0 0ｸ7026ｧ80ｹ0 0ｸ7apple ｸ707 00fi0708 apple 閨07000ｹ 閨02000ｹ ｸ ｷ ｦ 閨 閨0ｷ30ｹ0 70% 020ｷ307 apple000306apple ｷ307. ﾌ06 Ulm ｸ 閨 ｸ7applefi fi apple ｧ ｷ ｧ apple fi ｸ ｦ apple ｷ3046ｧ8 apple03fi09070ｷ 縺 applefi 0ｸ702fi 閨0ｹ ｦ ｧ ｷ ｷ ｧ8 070ｷ ｧ 閨 ｸ Dandy Walker 6ｧ8 apple ｧ80ｹ ｸ7 040ｸ707 03fi00080ｸ7 apple applefi 02060ｹ ｹ ｹ0 026ｦ ｹ0 040ｸ fi ｹ 閨 ｸ ｷ30409 Dandy Walker 6ｧ8 apple ｧ80ｹ ｸ7, ｦ ｷ ｸ ｦ ｧ fi ｸ70407fi ｷ ｸ ｸ7apple apple ｸ700 閨070ｷ ｸ ｷ ｧ ｸ fi 閨 ｸ Dandy Walker apple080ｸ7 06 apple apple ｹ ｹ ｹ0 026ｦ ｹ 閨 ｸ7026ｧ8 apple080ｸ 閨 fi ｧ90ｷ30ｹ0.(8 applefi applefi 14) ｷ ｷ 閨0ｹ0 070ｷ ｧ9000ｹ0 6ｧ apple ｸ70407 閨0ｹ ｦ ｦ00ｷ apple ｸ7 040ｸ707 03fi00080ｸ7. ﾇ ｧ ｧ9 020ｷ307 apple ｸ7 040ｸ707-03fi00080ｸ7 閨 ｧ9 02 apple ｦ fi ｾ ｧ 閨0209 applefi Chang ｸ ｸ7apple ｧ ｦ00ｷ ｧ ｸ ( ｸ ｧ ｹ ｧ9, apple036ｧ ｧ9 ) 09fi applefi 閨 ｸ7 00apple 險B 閨 fi applefi ｨB apple fi ｹ0 ｨB0ｷ36ｧ80ｹ ｸ70ｹ0. 6ｾ40ｸ70708 閨0ｹ0 070ｷ ｧ9000ｹ ｧ % 020ｷ apple036ｧ ｧ ｸ % 020ｷ ｸ7apple08apple03 046ｧ ｸ ｸ ｧ ｹ ｸ ﾒ 030ｸ708020ｸ7apple0602 閨0ｹ0 72

5 070ｷ ｧ9000ｹ ｧ % 020ｷ ｦ00ｷ apple036ｧ ｧ ｸ % 0400 閨 ｸ apple03 046ｧ ｸ ｸ ｧ ｹ0. ﾌ06 apple ｸ70407 閨0ｹ ｷ ｷ 閨0ｹ0 070ｷ ｧ9000ｹ0 6ｧ ｷ3006ｧ9 13, ﾑ apple6ｧ904090ｹ0 apple ｧ ｧ80ｹ ｧ ｸ ｹ0 apple ｧ9 0ｹ0 (6ｾ46ｦ Joubert). ﾇ ｧ80ｹ ｧ ｸ ｸ ｦ apple000604fi 06 0ｸ7apple apple076ｧ9 0ｹ0, apple 閨0ｹ ｧ ｹ0 020ｷ , ｧ9, ｧ ｸ70402 閨 ｧ ｸ ｷ fi 0ｸ7apple applefi fiapple ｾ ｧ 閨 ｸ 閨07080ｸ ｦ007080ｸ7, 03fi090ｷ ｦ0, 閨 ｧ 閨 ｹ ｹ ｹ0 026ｦ ｹ0, apple apple03 閨0ｹ ｹ0 070ｷ3036ｧ ｦ ｧ ｷ 閨0ｹ0. 17,18 010ｷ3036ｧ90ｹ 閨0ｹ fi ｦ Joubert apple ｧ ｧ9 0ｸ7apple applefi ｷ300 閨0709 Dandy Walker ｧ8. ﾇ apple ｧ ｷ ｧ apple fiapple ｷ307 apple ｧ90ｷ ｹ ｹ ｧ80ｹ0, ｹ ｸ ｧ ｸ70ｹ ｸ ｧ ｹ ｹ ｧ ｹ ｸ70ｹ 閨 ｧ ｷ30409 apple03 鐶pple ｧ fi ｸ7036ｧ ｧ9 026ｦ ｸ7 08apple ｧ9080ｸ7 6 5fi ｸ7 applefi ｧ8 026ｦ ｧ9 08apple apple ｧ ｧ80ｹ0 026ｦ ｧ fi ｸ704076ｧ apple0608 6ｧ8apple06 070ｷ ｧ9 applefi ｦ Dandy Walker, 06fi apple00036ｧ9apple020ｷ ｸ7026ｧ8 08 0ｸ7apple ｧ ｹ 閨 ｹ0 006ｧ 閨07080ｹ0 080ｸ ﾞ0ｸ7026ｧ apple ｸ ｧ9 閨07 apple fi fi ｧ ｸ ｧ ｨB apple080ｸ ｷ3036ｧ9ｨB apple ｧ ｦ Dandy Walker ｧ80ｹ0 026ｦ apple6ｧ9ｨB ｸ 閨 ｨB ｸ apple6ｧ904090ｹ ｧ ｸ702fi fi apple ｧ ｧ ｷ fi. 6ﾑ86ｧ fi ｧ fi0ｹ ｦ0080ｸ ｦ ｸ7 08apple6ｧ ｸ7 6 5fi ｸ ｦ007 apple 閨0ｹ ｹ0 00 閨04090ｹ ｧ80ｹ ｷ ｸ ｧ9080ｸ apple0ｷ30ｹ0 閨 ｷ303006ｧ9 070ｷ3036ｧ , ｧ9 00apple ｧ9 07 apple 03080ｸ ｧ apple ｧ ｧ8 0ｸ 閨 ｧ apple ｧ9 apple080ｸ7 040ｸ ｦ applefi ｧ ｸ ｧ9-080ｸ 鐶pple ｨB ｦ ｧ9 0ｸ7apple ｹ ｧ9 0ｹ ｸ ｧ9080ｸ apple apple ｧ ｧ80ｹ0 026ｦ apple ｧ9 07 apple 閨 ｷ applefi 040ｸ700apple6ｧ ｦ ｹ0 0ｸ702 閨0ｹ ｸ ｦ ｧ ｸ fi ｸ7 6ｧ apple ｧ9. ﾞ070ｷ ｧ9 Arnold ｨC Chiari ﾇ 070ｷ ｧ9 Arnold-Chiari 006ｧ ｷ ｧ ｸ7 08apple6ｧ ｸ ｸ7 apple080ｸ7 apple ｧ applefi 6ｦ 閨 ﾒ208 apple ｧ fi03080ｸ ｦ fiapple ｦ0 apple080ｸ7 apple0308 閨 applefi ｧ ｸ ｹ0 apple ｧ9 0ｹ0 00 閨 apple0807 0ｸ fi 02036ｧ800. 6ﾒ ｦ ｧ ｧ9 fi ｸ703 6ｧ fiapple ｹ0 09 閨080ｸ703 0ｹ0, 02090ｹ0 02 閨 ｹ ｧ9 0ｹ ｸ7 apple ｧ ｸ ｦ 閨04080ｸ ｸ ｸ ｧ ｹ0 00 閨 apple0807 0ｸ fi 0ｸ7-03fi. ﾞ0ｸ702fi 040ｸ7076ｧ8030ｷ30ｹ0 040ｸ ｦ ｸ 閨 ｸ ｧ ﾞ07 08 閨 fi apple fi ｹ0 apple000306apple ｹ ｦ00ｹ ｹ0 00apple06apple03 閨 applefi ｧ8 Arnold Chiari fi 閨0ｷ30ｹ0 95% 0ｸ ｷ apple 03080ｸ ｨB080ｸ707 0ｸ 閨 ,23 ﾇ ｧ8 Arnold Chiari apple ｧ9 閨 fi 006ｧ ｧ ｦ008 apple ｷ ｸ7apple ｧ9 閨04080ｸ707 apple ｧ ｧ8 Arnold Chiari ｧ ｧ ｸ ｦ0 fiapple080ｸ ｸ ｷ ｷ3apple06 6ｧ90ｷ apple ｧ ｧ ｧ ｹ ｦ fi03080ｷ ｧ ｸ7 apple 閨07080ｸ ｦ0080ｸ ｧ ｸ7 000ｸ702 閨03080ｸ ｧ807080ｸ7. ﾇ 080ｸ7-03 6ｧ fiapple ｸ ｦ ｦ0 08 6ｧ apple ｸ7026ｧ ｸ ﾇ fiapple ｹ0 apple ｧ9 080ｹ0 apple ｧ ｹ0 (02 08apple086ｧ ｸ fi 02080ｸ70ｹ ｧ800 ) 096ｧ apple6ｧ9apple00, ｧ8 040ｸ700apple06 險B ｦ0apple0ｷ ｸ ｧ apple fi ｸ 閨0ｹ apple ｦ0apple ｧ ｹ0 00apple ｹ0, apple086ｧ908 00apple ｧ ｧ9 applefi 0208 apple ｧ ｾ ｧ9000ｹ0 apple000306apple ｹ0 02 apple ｧ apple ｧ ｧ9ｨB ｸ7 0ｸ7apple ｦ 閨 ｸ ｹ ｧ80ｹ ｸ ｦ0080ｸ7. ﾞ0ｸ7026ｧ ｧ8 0ｸ7apple ｧ

6 ｹ ｸ7 08apple ｧ9080ｸ7 6 5fi ｸ7 ｨCDandy Walker 046ｦ ﾒ 閨 ｸ707. apple03 鐶pple apple08066ｧ ｸ7apple ｧ ｧ Posterior fossa abnormalities ｨC Dandy Walker Syndrome Ch. ﾒallideri, D. ﾒassanos, 6ﾑ8. 6ｾ4alamalekis 3rd Department of Obstetrics and Gynaecology, University of Athens P.G.N. ｱAttikon ｱ, Athens, Greece A ｧ9 : D. Kassanos 1 Rimini str., Chaidari, Greece 6ﾒ2el.: , direct: [email protected] Summary Dandy Walker syndrome indicates the association of 1) ventriculomegaly of variable degree 2) a large cisterna magna 3) a defect in the cerebellar vermis through which the cyst communicates with the fourth ventricle. A wide spectrum of anomalies of the posterior fossa have been described but there are no clear criteria of distinction between them 1) classic Dandy Walker malformation, (enlarged posterior fossa, complete or partial agenesis of the cerebellar vermis and elevated tentorium) 2) the Dandy Walker variant (variable hypoplasia of the cerebellar vermis with or without enlargement of the posterior fossa) and 3) megacisterna magna (enlarged cisterna magna with integrity of both cerebellar vermis and fourth ventricle). Familial agenesis of the cerebellar vermis with episodic hypercapnia, abnormal eye movements, ataxia and early death define Jouberts syndrome. Without a family history of Jouberts syndrome, familial agenesis of cerebellar vermis would not be distinguishable sonographically from an isolated Dandy Walker malformation. The Arnold Chiari malformation is an anomaly of the hindbrain, with two components. The first a variable displacement of tissue derived from the inferior cerebellar vermis into the upper cervical canal. The second a similar caudal dislocation of the pons, the fourth ventricleand mededulla oblonganda to the spinal canal. Usually is associated with hydrocephalus and spina bifida. Key words: Dandy Walker syndrome, abnormalities of the vermis, enlargement of the fourth ventricle ｧ9 1) Nyberg, D.A, Cyr, D.R., and Mack, L.A. The Dandy Walker malformation: prenatal sonographic diagnosis and its clinical significance. J Ultrasound Med.1988., 7:65. 2) Harwood Nash D, Fitz C: Neuroradiology in infants and Children, 1976 vol.3 St Louis CV Mosby. 3) Hirsch JF, Pierre-Kahn A, Renier D, et al,: The Dandy Walker malformation: A review of 40 cases.1984.j Neurosurg61:515. 4) Warkany, J., Lemire, R.J., and Cohen., M.M: Mental retardation and Congenital Malformations of the central Nervous System. Chicago: Year Book1981.Pp ) Ecker JL, Shipp TD, Bromley B, Benacerraf B: The sonographic diagnosis of Dandy Walker and Dandy Walker variant: associated findings and outcomes. Prenat Diagn.2000 Apr;20(4): ) Murray JC, Johnson JA, Bird TD: Dandy Walker malformation: Etiologic heterogeneity and empiric recurrence risks.1985.clin.genet28:272. 7) Pilu G, Goldstein I, ReeceE, et al: Sonography of fetal Dandy Walker malformations: A reappraisal. UltrasoundObstetGynecol1992., 2:151. 8) Archiron R, Archiron A: Transvaginal ultrasonic assessment of the early fetal brain. Ultrasound Obstet Gynecol.1991.,1:336. 9) Russ,P. D. Pretorius, D.H., and Johnson, M.J. Dandy Walker syndrome: a review of fifteen cases evaluated by prenatal sonography. Am.J ObstetGynecol1989.,161:401 10) Pilu, G., et al Antenatal diagnosis and Obstetric management of Dandy Walker syndrome J Reprod. Med.1986.,31: ) Nyberg DA, Mahony BS, Heegge FN, et al: Enlarged 74

7 cisterna magna and the Dandy Walker malformation: Factors associated with chromosome abnormalities. Obstet Gynecol.1991.,77: ) Mahony B.S., Callen PW, Filly RA, et al: The fetal cisterna magna.radiology.1984.,153: ) Laing F, Frates M, Brown D, et al: Sonography of the fetal posterior fossa :False appearance of mega cisterna magna and Dandy Walker variant. Radiology : ) Ulm B, Ulm MR,Deutinger J et al: Dandy Walker malformation diagnosed before 21 weeks of gestation: Associated malformations and chromosomal abnormalities. Ultrasound Obstet Gynecol : ) Chang MC, Russel SA, Callen PW, et al: Sonographic detection of inferior vermian agenesisin Dandy Walker malformations: Prognostic implications. Radiology : ) ﾇodgins PR, Harris CM, Shwawkat FS, Thompson DA et al: Joubert syndrome :long ｨC term follow ｨC up Dev Med Child Neurol.2004;46(10) : ) Campbell, S., Tsannatos, C., and Pearce, J.M. The prenatal diagnosis of Jouberts syndrome of familial agenesis of the cerebellar vermis. prenat Diagn.1984.,4: ) Doherty D, Glass IA, Siebert JR, Strouse PJ, et al. Prenatal diagnosis in pregnancies at risk for Joubert syndrome by ultrasound and MRI. Pren Diagn ;25(6) : ) Dempsey PJ, Koch HJ: In utero diagnosis of the Dandy Walker syndrome: Differentiation from extraaxial posterior fossa cyst. J Clin Ultrasound 9:403, ) Smith AS, Levine D. Appearence of an intehemispheric cyst associated with agenesis of the corpus callosum. AJNR Am J Neuroradiol.2004;25(6): ) Babcook C.J., Goldstein R.B., Barth R.A., et al. Prevelance of ventriculomegalyin association with myelomeningocele. Correlation with gestational age and severity of posterior fossa deformity. 22) Bell, J.E., Gordon, A., and Malloney, A.F.J. The association of hydrocephalus and Arnold ｨC Chiari malformation with spina bifida in the fetus.neuropathol.appl.neurobiol :29. 23) McIntosh, R. The incidence of congenital malformations: a study of 5964 pregnancies.pediatrics : ) Bernard J.P., Suares B., Rambaud C et al.prenatal diagnosis of neural tube defect before 12 weeks gestation. Direct and indirect ultrasonographic semeiology Ultrasound Obstet Gynecol1997.(6) : ) Nicolaides, K.M., et al Ultrasound screening for spina bifida: cranial and cerebellar sings. Lancet :72. 26) Benacerraf, B.R., Stryker, J., and Frigolleto, F.D. Abnormal ultrasound appearance of the cerebellum(banana sing ):indirect sing of spina bifida. Radiology : ) Campbell, J. et al. Ultrasound screening for spina bifida: cranial and cerebellar signs in a high risk population. Obstet Gynecol : ) Gabe,S.G., et al. Detection of open spina bifida by the lemon sign: pathologic correlation:j.clin.ultrasound :