KASSANOS teliko

∞ÏÏËÏÔÁÚ·Ê›·: ƒ›ÌÈÓÈ 1, 12462 ÷˚‰¿ÚÈ ∆ËÏ.: 210-5831000, ÂÛˆÙ. 2214 e-mail: [email protected] ∫·Ù·Ù¤ıËΠ10.4.2005 ŒÁÈÓ ‰ÂÎÙ‹ 25.4.2005 Ã. ∫·ÏÏÈÓÙ¤ÚË, ¢. ∫·ÛÛ¿ÓÔ˜, ∂. ™·Ï·Ì·Ï¤Î˘. °’ ª·È¢ÙÈ΋ Î·È °˘Ó·ÈÎÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¶.°.¡. «∞∆∆π∫√¡».

µÏ¿‚˜ ÙÔ˘ ÔÈÛı›Ô˘

‚fiıÚÔ˘ –Dandy Walker

Û‡Ó‰ÚÔÌÔ

¶ÂÚ›ÏË„Ë

·˘-Ïfi. ∆Ô ‰Â‡ÙÂÚÔ Â›Ó·È Ì›· fiÌÔÈ· Ô˘Ú·›· ÌÂÙ·ÙfiÈ-ÛË Ù˘ Á¤Ê˘Ú·˜, Ù˘ ٤ٷÚÙ˘ ÎÔÈÏ›·˜ Î·È ÙÔ˘ ÚÔÌ‹ÎË Ì˘ÂÏÔ‡ ‰È·Ì¤ÛÔ˘ ÙÔ˘ ÈÓÈ·ÎÔ‡ ÙÚ‹Ì·ÙÔ˜ ÛÙÔ ÛÔÓ‰˘ÏÈÎfi ·˘Ïfi. ™˘Ó‹ıˆ˜ Û˘Óԉ‡ÂÙ·È Ì ˘‰ÚÔΤʷÏÔ Î·È ÌËÓÈÁÁÔÌ˘ÂÏÔ΋ÏË. §¤ÍÂȘ-ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ Dandy Walker, ·ÓˆÌ·Ï›Â˜ ‰È¿-Ï·Û˘ ÙÔ˘ ÛÎÒÏËη, ‰È¿Ù·ÛË Ù˘ ÙÂÙ¿ÚÙ˘ ÎÔÈÏ›·˜ ∂ÈÛ·ÁˆÁ‹ – ∞Ó·ÙÔÌ›· ∆Ô Û‡Ó‰ÚÔÌÔ Dandy Walker ÂÚÈÏ·Ì‚¿ÓÂÈ ÌÈ· ÛÂÈÚ¿ ·ÓˆÌ·ÏÈÒÓ ÔÈ Ôԛ˜ ÔÊ›ÏÔÓÙ·È Û ·ıÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË Ù˘ ·ÚÂÁÎÂÊ·Ï›-‰·˜ . ∆Ô Û‡Ó‰ÚÔÌÔ ·˘Ùfi Â›Ó·È ·ÔÙÂÏ› ¤Ó· Ê¿ÛÌ· ‰È·Ù·Ú·¯ÒÓ Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ˘Ô-Ï·Û›· Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Î·È ÙË Û˘ÓÔ‰fi η΋ ·Ó¿Ù˘ÍË Ù˘ ٤ٷÚÙ˘ ÎÔÈÏ›·˜. ∫˘Ú›·Ú-¯Ô ‡ÚËÌ· Â›Ó·È Ë ÌÂÁ¿ÏË ‰È¿Ù·ÛË Ù˘ ٤ٷÚ-Ù˘ ÎÔÈÏ›·˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ,Ë ÔÔ›· ÌÂÁ·ÏÒ-ÓÂÈ ÙfiÛÔ Ôχ ÒÛÙ ηٷϷ̂¿ÌÂÁ·ÏÒ-ÓÂÈ Î·È ‰È·Ù›-ÓÂÈ ÙÔÓ Ô›ÛıÈÔ ‚fiıÚÔ. ™˘Ó‰˘¿˙ÂÙ·È Ì ‰È·ÊfiÚÔ˘ ‚·ıÌÔ‡ ‰È¿Ù·ÛË ÙˆÓ Ï·Á›ˆÓ ÎÔÈÏÈÒÓ Ì ‰È·ÙÂٷ̤ÓË ÌÂÁ¿ÏË ‰ÂÍ·ÌÂÓ‹ Î·È ¤ÏÏÂÈÌÌ· ÙÔ˘ ÛÎÒÏËη Ù˘ ·-ÚÂÁÎÂÊ·Ï›‰·˜ ̤ۈ ÙÔ˘ ÔÔ›Ô˘ Ë ÌÂÁ¿ÏË ‰Â-Í·ÌÂÓ‹ ÂÈÎÔÈÓˆÓ› Ì ÙËÓ Ù¤Ù·ÚÙË ÎÔÈÏ›·.1 ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰È¿ÊÔÚÔÈ ÔÚÈÛÌÔ› ¤¯Ô˘Ó ÚÔÙ·ı› ÁÈ· Ó· ‰ËÏÒÛÔ˘Ó ÙËÓ ÔÌ¿‰· ÙˆÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ Ô›ÛıÈÔ˘ ‚fiıÚÔ˘ Ô˘ ÌÔÈ¿-˙Ô˘Ó Ì ÙÔ ÎÏ·ÛÛÈÎfi Û‡Ó‰ÚÔÌÔ Dandy Walker. √È ÂÚÈÛÛfiÙÂÚÔÈ ÔÚÈÛÌÔ› ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Ù· ·ÎfiÏÔ˘ı· Â˘Ú‹Ì·Ù·: 1) ΢ÛÙÈ΋ ‰È¿Ù·ÛË Ù˘ ٤ٷÚÙ˘ ÎÔÈÏ›·˜ ,2) ‰˘ÛÁÂÓÂÛ›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Î·È 3) ˘„ËÏ‹ ı¤ÛË ÙÔ˘ ÛÎËÓȉ›Ô˘. ∂› ÙÔ˘ ·ÚfiÓÙÔ˜, Ô fiÚÔ˜ Dandy Walker ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· Ó· ‰Â›ÍÂÈ ¤Ó· Ê¿ÛÌ· ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ Ô›ÛıÈÔ˘ ‚fiıÚÔ˘ ÔÈ Ôԛ˜ Ù·ÍÈÓÔÌÔ‡ÓÙ·È ·fi ÙËÓ ·ÍÔÓÈ΋ ˘Ô-ÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›· (CT scans) ˆ˜ ·ÎÔÏÔ‡-ıˆ˜: 1) ÎÏ·ÛÛÈ΋ Dandy Walker ·ÓˆÌ·Ï›·, (‰È¿Ù·ÛË ÙÔ˘ Ô›ÛıÈÔ˘ ‚fiıÚÔ˘, Ï‹Ú˘ ‹ ÌÂ-ÚÈ΋ ·ÁÂÓÂÛ›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·-Ï›‰·˜, ·Ó˘„ˆÌ¤ÓÔ ÛÎËÓ›‰ÈÔ) 2) ·Ú·ÏÏ·Á‹ ÙÔ˘ Dandy Walker (ÔÈΛÏË ˘ÔÏ·Û›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Ì ‹ ¯ˆÚ›˜ ‰È¿Ù·ÛË ÙÔ˘ Ô›ÛıÈÔ˘ ‚fiıÚÔ˘) Î·È 3) ‰È·ÙÂ-ٷ̤ÓË ÌÂÁ¿ÏË ‰ÂÍ·ÌÂÓ‹ Ì ·Î¤Ú·ÈÔ ÙÔ ÛÎÒ-ÏËη Î·È ÙËÓ Ù¤Ù·ÚÙË ÎÔÈÏ›· (mega-cisterna magna).2 ∞Ó Î·È Ô ˘‰ÚÔΤʷÏÔ˜ ¤¯ÂÈ ıˆÚËı› fiÙÈ Â›-Ó·È ¤Ó· Ô˘ÛÈ·ÛÙÈÎfi ‰È·ÁÓˆÛÙÈÎfi ÛÙÔÈ¯Â›Ô ÛÙÔ Û‡Ó‰ÚÔÌÔ Dandy Walker, ÈÔ ÚfiÛÊ·Ù˜ ÌÂ-ϤÙ˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Î·È ÛÙÔ ÎÏ·ÛÛÈÎfi Û‡Ó-‰ÚÔÌÔ Ë ‰È¿Ù·ÛË ÙˆÓ ÎÔÈÏÈÒÓ ‰ÂÓ Â›Ó·È Úˆ-Ù·Ú¯ÈÎfi ‡ÚËÌ· ηٿ ÙË Á¤ÓÓËÛË ÛÙÔ˘˜ Â-ÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓ›˜ ·ÏÏ¿ ·Ó·Ù‡ÛÛÂÙ·È Û˘¯Ó¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜.3 ∏ ·ÓˆÌ·Ï›· Dandy Walker ÂÌÊ·Ó›˙ÂÙ·È ÌÂ Û˘¯ÓfiÙËÙ· 1/ 30000 ÁÂÓÓ‹ÛÂȘ Î·È Â˘Ú›ÛÎÂÙ·È Û 4% ¤ˆ˜ 12% fiÏˆÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÓÂÔ-ÁÓÈÎÔ‡ ˘‰ÚÔΤʷÏÔ˘. ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ·-Ú·ÏÏ·ÁÒÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Î·È Ù˘ ‰È·ÙÂٷ̤-Ó˘ ÌÂÁ¿Ï˘ ‰ÂÍ·ÌÂÓ‹˜ Â›Ó·È ¿ÁÓˆÛÙË. £Âˆ-ڛ˜ ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÛË ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·ÙÚËÛ›· ÙˆÓ ÙÚËÌ¿ÙˆÓ Luschka Î·È Magendie ·Ó Î·È ·˘Ù¿ ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿-˙Ô˘Ó Î¿ÔÈ· ‰È·‚·ÙfiÙËÙ· Î·È Ê·›ÓÂÙ·È Ó· ˘¿Ú¯ÂÈ ˘ÔÏ·Û›· Î·È Î¿ÔÈÔ˘ ‚·ıÌÔ‡ ·-ıÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜.4 º·›ÓÂÙ·È fiÙÈ ÛÙËÓ ·ÈÙ›· ·˘Ù‹˜ Ù˘ ηٿÛÙ·-Û˘ ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÁÂÓÂÙÈÎÔ› ·Ú¿-ÁÔÓÙ˜. ∏ ·ÓˆÌ·Ï›· Dandy Walker ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ÌÂÓÙÂÏÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È Û ¯ÚˆÌ·ÙÔۈ̷ÙÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ∂¿Ó ‰ÂÓ ·ÔÙÂÏ› ̤ÚÔ˜ ·Ó·ÁÓˆÚÈṲ̂ÓÔ˘ Û˘Ó‰ÚfiÌÔ˘, Ô Î›Ó‰˘ÓÔ˜ Â·ÓÂÌÊ¿ÓÈÛ˘ Â›Ó·È 1% ¤ˆ˜ 5%.™Â Û¿ÓȘ ÂÚÈÙÒÛÂȘ Ë ·Ûı¤ÓÂÈ· ÎÏË-ÚÔÓÔÌÂ›Ù·È Ì ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ÙÚfiÔ.5 ¶ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÊÏÂÁÌÔÓ¤˜ ·fi ÈÔ‡˜, Ï‹„Ë ·ÏÎÔfiÏ Î·È ‰È·‚‹Ù˘ Ù˘ ÌËÙ¤Ú·˜ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∏ Ù·ÍÈÓfiÌËÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ¤ÁÈÓ ηχÙÂÚË Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ MRI. °È· ‰È·ÊfiÚÔ˘˜ ÏfiÁÔ˘˜ ÔÈ ·ÏÏÂ¿ÏÏËϘ ÙÔ̤˜ Ô˘ ·Ú·‰ÔÛȷο ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙËÓ CT ‰ÂÓ ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó· ÂÎÙÈÌ‹ÛÔ˘Ó Ì ·ÎÚ›‚ÂÈ· ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂ-ÁÎÂÊ·Ï›‰·˜ Î·È ÌÔÚÔ‡Ó Ó· ˘ÔÂÎÙÈÌ‹ÛÔ˘Ó ‹ Ó· ˘ÂÚÂÎÙÈÌ‹ÛÔ˘Ó ÙÔ Ì¤ÁÂıÔ˜ ÂÓfi˜ ÂÏÏ›Ì-Ì·ÙÔ˜. ∏ ÂÍ·ÈÚÂÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ÂÈ̋ΈÓ

ÂÈ¤-‰ˆÓ Ô˘ ÂÈÙ‡¯ıËΠ̠ÙËÓ MRI ·¤‰ÂÈÍ fiÙÈ Ë Ù·ÍÈÓfiÌËÛË Ô˘ ¤ÁÈÓ Ì ÙËÓ CT ‹Ù·Ó ·ÓÂ·Ú΋˜ Ó· ÂÚÈÁÚ¿„ÂÈ ÙËÓ ·Ó·ÙÔÌÈ΋ ‰È·-Ù·Ú·¯‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Dandy Walker. ∫¿-ÔÈÔÈ ‚·ıÌÔ› ‰˘ÛÁÂÓÂÛ›·˜ ÙÔ˘ ÛÎÒÏËη ÌÔ-ÚÔ‡Ó Ó· ¢ÚÂıÔ‡Ó Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ, ·ÎfiÌË Î·È fiÙ·Ó ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË ‰È¿Ù·ÛË Ù˘ ÌÂÁ¿Ï˘ ‰ÂÍ·ÌÂÓ‹˜, ÂÓÒ Ë ÎÏ·ÛÛÈ΋ ÌÔÚÊ‹ Î·È ÔÈ ·Ú·ÏÏ·Á¤˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ¤¯Ô˘Ó Ùfi-Û˜ ÔÌÔÈfiÙËÙ˜ Ô˘ ¤Ó·˜ Û·Ê‹˜ ‰È·¯ˆÚÈÛÌfi˜ ÌÔÚ› Ó· Â›Ó·È ·‰‡Ó·ÙÔ˜. To Û‡Ó‰ÚÔÌÔ ·˘Ùfi ÌÔÚ› Ó· Û˘Óԉ‡ÂÙ·È Û˘¯Ó¿ Î·È Ì ¿ÏϘ ‚Ï¿‚˜ ÙÔ˘ ¡Â˘ÚÈÎÔ‡ ™˘-ÛÙ‹Ì·ÙÔ˜ ΢ڛˆ˜ ‰È¿Ù·ÛË ÙˆÓ ÎÔÈÏÈÒÓ, Î·È ‚Ï¿‚˜ Ù˘ ̤Û˘ ÁÚ·ÌÌ‹˜, fiˆ˜ ·ÁÂÓÂÛ›· ÙÔ˘ ÌÂÛÔÏÔ‚›Ô˘, ÔÏÔÚÔÛÂÁÎÂÊ·Ï›· Î·È ÂÁÎÂÊ·ÏÔ΋Ϙ. ™Â ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ ¤¯ÂÈ ÂÚÈÁÚ·Ê› Ë ·ÚÔ˘Û›· ÔÏ˘‰·ÎÙ˘Ï›·˜, ·Óˆ-Ì·ÏÈÒÓ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ηÚ-‰È·ÁÁÂȷΤ˜ ·ÓˆÌ·Ï›Â˜ Î·È Û¯ÈÛٛ˜ ÙÔ˘ ÚÔ-ÛÒÔ˘.6 ªÂϤÙ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÂÌÊ·Ó›˙Ô˘Ó Û˘¯Ófi-ÙËÙ· Û˘ÓÔ‰ÒÓ ·ÓˆÌ·ÏÈÒÓ Ô˘ Î˘Ì·›ÓÔÓÙ·È ÌÂٷ͇ 50% Î·È 70%. ÀÂÚ˯ÔÁÚ·Ê›· ∏ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘ ÎÏ·ÛÛÈÎÔ‡ Dandy Walker Â›Ó·È ‰˘Ó·Ù‹ Û˘Ó‹ıˆ˜ ·fi ÙÔ 2Ô ÙÚ›ÌËÓÔ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘7 _{fï˜ ¤¯ÂÈ} ·Ó·-ÊÂÚı› Î·È ·fi ÙË 14Ë Â‚‰ÔÌ¿‰· Ù˘ ·ËÛ˘ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ‰È·ÎÔÏÈ΋ ˘ÂÚ˯ÔÁÚ·-Ê›·.8 ™Â ˘ÈÓÈÔ‚ÚÂÁÌ·ÙÈ΋ ÙÔÌ‹, Ô˘ Ê·›ÓÂÙ·È Ë ·ÚÂÁÎÂÊ·Ï›‰·, ˘ÂÚ˯ÔÁÚ·ÊÈο ‰È·ÈÛÙÒ-ÓÂÙ·È Ì›· ‰È·ÙÂٷ̤ÓË Ô›ÛıÈ· ‰ÂÍ·ÌÂÓ‹ Ô˘ ÂÈÎÔÈÓˆÓ› Ì ÙËÓ ÂÚÈÔ¯‹ Ù˘ ٤ٷÚÙ˘ ÎÔÈ-Ï›·˜ ̤ۈ ÂÏÏ›ÌÌ·ÙÔ˜ ÙÔ˘ ·ÚÂÁÎÂÊ·ÏȉÈ-ÎÔ‡ ÛÎÒÏËη (∂ÈÎfiÓ· 1) ™˘¯Ó¿ ÌÔÚ› Ó· ·Ó¢ÚÂıÔ‡Ó ÔÚȷ΋ ̤¯ÚÈ ÂÎÙÂٷ̤ÓË ÎÔÈÏÈÔ-ÌÂÁ·Ï›· Î·È ¿ÏϘ ‚Ï¿‚˜ ·fi ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ηıÒ˜ Î·È Û˘ÓÔ‰¤˜ ‰È·Ù·-Ú·¯¤˜ ·fi ¿ÏÏ· Û˘ÛÙ‹Ì·Ù·. ∂ÓÙÔ‡ÙÔȘ Û ÂÚÈÙÒÛÂȘ Ì ÌÂÚÈ΋ ·ÁÂÓÂ-Û›· ÙÔ˘ ÛÎÒÏËη ÛÙÔ Î·ÙÒÙÂÚÔ ÙÔ˘ ÙÌ‹Ì· ,Ë ÎÏ·ÛÛÈ΋ ÙÔÌ‹ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ·ÚÂ-ÁÎÂÊ·Ï›‰· ÌÔÚ› Ó· ÌËÓ Â›Ó·È ‰È·ÁÓˆÛÙÈ΋ Î·È Ó· ··ÈÙËı› Â›ÌÔÓË ‰ÈÂÚ‡ÓËÛË ÁÈ· Ó· ‰È·ÈÛÙˆı› ÙÔ ¤ÏÏÂÈÌÌ·. ÃÚÂÈ¿˙ÂÙ·È ‰ËÏ·‰‹ ¤ÏÂÁ¯Ô˜ Ì ̛· ¯·ÌËÏfiÙÂ-ÚË ÙÔÌ‹ ÁÈ· Ó· ·Ô‰ÂȯÙ› fiÙÈ ÙÔ Î·ÙÒÙÂÚÔ ÙÌ‹Ì· ÙÔ˘ ÛÎÒÏËη ¯ˆÚ›˙ÂÈ ÙËÓ Ù¤Ù·ÚÙË ÎÔÈ-Ï›· ·fi ÙËÓ ÌÂÁ¿ÏË ‰ÂÍ·ÌÂÓ‹ Î·È Ó· ·Ô-ÎÏÂÈÛÙ› ¤ÙÛÈ ·˘Ù‹ Ë Î·Ù¿ÛÙ·ÛË.9 ∫ÚÈÙ‹ÚÈ· ÁÈ· ÔÚÈÛÙÈ΋ ‰È¿ÁÓˆÛË Ù˘ ‰È·ÙÂÙ·-̤Ó˘ ÌÂÁ¿Ï˘ ‰ÂÍ·ÌÂÓ‹˜ Î·È ÙˆÓ ·Ú·ÏÏ·-ÁÒÓ Dandy Walker ‰ÂÓ ¤¯Ô˘Ó ·˘ÛÙËÚ¿ ηıÔ-ÚÈÛÙ› ̤¯ÚÈ ÙÒÚ·.10 _{∆ËÓ ‰È·ÙÂٷ̤ÓË ÌÂÁ¿ÏË} ‰ÂÍ·ÌÂÓ‹ Ú¤ÂÈ Ó· ÙËÓ ˘ÔÙ¢fiÌ·ÛÙ fiÙ·Ó ÙÔ ‚¿ıÔ˜ Ù˘ ÌÂÁ¿Ï˘ ‰ÂÍ·ÌÂÓ‹˜ Â›Ó·È ÌÂÁ·-χÙÂÚÔ ·fi10mm,11_{Î·È ÙËÓ ·Ú·ÏÏ·Á‹ ÙÔ˘} Û˘Ó‰ÚfiÌÔ˘ fiÙ·Ó Ì›· ÌÈÎÚ‹ ÂÈÎÔÈÓˆÓ›· ‚Ú›-ÛÎÂÙ·È ÌÂٷ͇ Ù˘ ٤ٷÚÙ˘ ÎÔÈÏ›·˜ Î·È Ù˘ ÌÂÁ¿Ï˘ ‰ÂÍ·ÌÂÓ‹˜. ™ÙȘ ·Ú¯¤˜ ÙÔ˘ 2Ô˘ ÙÚÈÌ‹ÓÔ˘ Ë ˘ÂÚ˯ÔÁÚ·-ÊÈ΋ ÂÌÊ¿ÓÈÛË Ê˘ÛÈÔÏÔÁÈ΋˜ ·Ó¿Ù˘Í˘ Ù˘ ∂ÈÎfiÓ· 1: ™‡Ó‰ÚÔÌÔ Dandy Walker. ¢ÂÓ ·Ú·ÙËÚÂ›Ù·È ·ÚÂÁÎÂÊ·Ï›‰· Û ˘ÈÓÈÔ‚ÚÂÁÌ·ÙÈ΋ ÙÔÌ‹ ∂ÈÎfiÓ· 2: ∞Á¤ÓÂÛË ÙÔ˘ ÛÎÒÏËη Î·È ˘‰ÚÔÎÂÊ·Ï›·

ÂÚÂÁÎÂÊ·Ï›‰·˜ ÌÔÚ› Ó· ÌËÓ ·Ôηχ„ÂÈ ÙË ÓfiÛÔ. ∏ Û¯ÂÙÈο ÌÂÁ¿ÏË Ù¤Ù·ÚÙË ÎÔÈÏ›· Î·È Ô ·ÓÂ-·Ú΋˜ Û¯ËÌ·ÙÈÛÌfi˜ ÙÔ˘ ÛÎÒÏËη ÌÔÚ› Ó· ‰ÒÛÔ˘Ó ÙËÓ ÂÛÊ·Ï̤ÓË ÂÓÙ‡ˆÛË ÙÔ˘ ÂÏÏ›Ì-Ì·ÙÔ˜ ÛÙÔ ÛÎÒÏËη .∂›Ó·È ÂÔ̤ӈ˜ ÚÒÈÌÔ Ó· οÓÂÈ Î·Ó›˜ ÙË ‰È¿ÁÓˆÛË Ù˘ ¤ÏÏÂȄ˘ ÙÔ˘ ÛÎÒÏËη Û ·˘Ù‹Ó ÙËÓ ËÏÈΛ· ·ËÛ˘. ™˘-ÓÈÛÙ¿Ù·È Â·Ó¿ÏË„Ë ÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜ ÛÙȘ 18 ‚‰ÔÌ¿‰Â˜ ‹ Î·È ·ÚÁfiÙÂÚ·. ∞ÎfiÌË Î·È ÛÙÔ 2Ô ‹ 3Ô ÙÚ›ÌËÓÔ Ì›· ÏÔÍ‹ ÎÏ›ÛË Ù˘ ÁˆÓ›·˜ Û¿ÚˆÛ˘ ÌÔÚ› Ó· ‰ÒÛÂÈ ÙËÓ ÂÓÙ‡-ˆÛË Ù˘ ·‡ÍËÛ˘ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ÌÂÁ¿Ï˘ ‰ÂÍ·ÌÂÓ‹˜, Î·È ÂÏÏ›ÌÌ·ÙÔ˜ ÙÔ˘ ÛÎÒÏËη.12 ∏ ·Ú¯‹ ÙÔ˘ Ù¯ÓÈÎÔ‡ ·˘ÙÔ‡ ÛÊ¿ÏÌ·ÙÔ˜ Â›Ó·È ·Û·Ê‹˜. Œ¯ÂÈ ˘ÔÙÂı› fiÙÈ ÌÔÚ› Ó· ‰ËÌÈ-Ô˘ÚÁËı› ·fi ÙËÓ ·ÚÔ˘Û›· ˘ÁÚÔ‡ ·Ó¿ÌÂÛ· ÛÙȘ ·‡Ï·Î˜ Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Ô˘ Ù›ÓÂÈ Ó· ÂÂÎÙ·ı› ÚÔ˜ Ù· ÂÌÚfi˜ Î·È Î·Ï‡ÙÂÙ·È ·fi ¤Ó· ÏÂÙfi ÌÂÌ‚Ú·Ó҉˜ Î¿Ï˘ÌÌ· ÙÔ ÔÔ›Ô ‰ÂÓ ÌÔÚ› Ó· Á›ÓÂÈ ·ÓÙÈÏËÙfi Ì ÙË ‰Â-‰Ô̤ÓË ·Ó¿Ï˘ÛË Ù˘ ÂÈÎfiÓ·˜ ·fi ÙÔÓ ˘¿Ú-¯ÔÓÙ· Ù¯ÓÔÏÔÁÈÎfi ÂÍÔÏÈÛÌfi. ∏ ·Ú·Î›ÌÂ-ÓË ı¤ÛË ÙˆÓ ·˘Ï¿ÎˆÓ Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜, ‰ËÌÈÔ˘ÚÁ› ÙËÓ ÂÓÙ‡ˆÛË Ù˘ ÂÈÎÔÈÓˆÓ›·˜ ÌÂٷ͇ Ù˘ ٤ٷÚÙ˘ ÎÔÈÏ›·˜ Î·È Ù˘ ÌÂÁ¿Ï˘ ‰ÂÍ·ÌÂÓ‹˜, fiÌÔÈ· Ì ·˘Ù‹ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È Û CT ÌÂϤÙ˜ Ù˘ ·Ú·ÏÏ·Á‹˜ ÙÔ˘ Û˘Ó‰Úfi-ÌÔ˘ Dandy Walker. ∏ ÂÈÛÎfiËÛË ÙÔ˘ ÔÈ-Ûı›Ô˘ ‚fiıÚÔ˘ Û ̤ÛÔ Â›Â‰Ô ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ Û ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ ÂÊfiÛÔÓ ÂÈÙÚ¤ÂÈ ÙËÓ ÂÈÛÎfiËÛË ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Û ԂÂÏÈ·›Ô Â›‰Ô.13 ∞ÎfiÌË Î·È ·˘Ù‹ Ë ÚÔÛ¤ÁÁÈÛË ÌÔÚ› Ó· ÌËÓ ÂÈÙÚ¤„ÂÈ ÙË Û·Ê‹ Ù·˘ÙÔÔ›ËÛË Ù˘ ‰˘ÛÁÂÓÂ-Û›·˜ Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜. ªÂ ‚¿ÛË Ù· ‰Â‰Ô̤ӷ, ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÂÈÙÚ¤ÂÈ ÙË ‰È¿ÁÓˆÛË Ìfi-ÓÔÓ ÛÔ‚·ÚÒÓ ·Ó·ÙÔÌÈÎÒÓ ·Ú·ÏÏ·ÁÒÓ ÙÔ˘ Dandy Walker ·˘Ù¤˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‰È·ÙÂÙ·-̤ÓË ÌÂÁ¿ÏË ‰ÂÍ·ÌÂÓ‹ Î·È ¤Ó· ¢ڇ ¤ÏÏÂÈÌÌ· ÙÔ˘ ·ÚÂÁÎÂÊ·ÏȉÈÎÔ‡ ÛÎÒÏËη Î·È ¯·Ú·-ÎÙËÚ›˙ÔÓÙ·È Û·Ó ÎÏ·ÛÛÈ΋ ‰È·Ù·Ú·¯‹ Dandy Walker. ∏ ÂÌÂÈÚ›· Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË Ì ÏÈÁfiÙÂÚÔ Û·Ê›˜ ·Ú·ÏÏ·Á¤˜. ∂›Ó·È Û˘¯Ó¿ ·‰‡Ó·ÙÔ Ó· ‰È·ÁÓˆÛÙ› ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi Â¿Ó ÚfiÎÂÈÙ·È ÁÈ· ÌÈ· ‰È·ÙÂٷ̤ÓË ÌÂÁ¿ÏË ‰ÂÍ·ÌÂÓ‹ ‹ ¤Ó· ÌÈÎÚfi ¤ÏÏÂÈÌÌ· ÛÙÔ ÛÎÒÏËη. ∏ ÎÏ·ÛÛÈ΋ ‰È·Ù·Ú·¯‹ Dandy Walker ÎÏÈÓÈ-ο ÂΉËÏÒÓÂÙ·È ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜, ÌÂ Û˘ÌÙÒÌ·Ù· ˘‰ÚÔÎÂÊ¿ÏÔ˘ ‹ ¿ÏÏˆÓ Ó¢ÚÔ-ÏÔÁÈÎÒÓ ÛËÌ›ˆÓ. Œ¯ÂÈ ·Ó·ÊÂÚı› ˘„ËÏ‹ ıÓËÛÈÌfiÙËÙ· ¤ˆ˜ 24% ÛÙȘ ÚÒÙ˜ Ó¢ÚÔ¯ÂÈ-ÚÔ˘ÚÁÈΤ˜ ÌÂϤÙ˜, ·ÏÏ¿ ÏfiÁˆ ÙˆÓ ÂÍÂÏ›ÍÂˆÓ ÛÙËÓ ·È‰È·ÙÚÈ΋ ·Ó·ÈÛıËÛ›· Î·È ÛÙȘ ¯ÂÈ-ÚÔ˘ÚÁÈΤ˜ Ù¯ÓÈΤ˜ ÔÈ ı¿Ó·ÙÔÈ Û·ÊÒ˜ ¤¯Ô˘Ó Á›ÓÂÈ ÏÈÁfiÙÂÚÔÈ. ∏ ÓÂ˘Ì·ÙÈ΋ ·Ó¿Ù˘ÍË ÛÙÔ˘˜ ÂÈ˙‹Û·ÓÙ˜ Â›Ó·È ·ÌÊÈÏÂÁfiÌÂÓË. ¢Â‰Ô̤Ó˘ Ù˘ Û·ÓÈfi-ÙËÙ·˜ Ù˘ ηٿÛÙ·Û˘ ·˘Ù‹˜ ˘¿Ú¯Ô˘Ó ÌfiÓÔ ÂÚÈÔÚÈṲ̂Ó˜ ÌÂϤÙ˜. ¶·Ú ·˘Ù¿ ÂÏ·Ùو̤-ÓË ÓÔËÌÔÛ‡ÂÏ·Ùو̤-ÓË ·Ó·Ê¤ÚÂÙ·È Û 40 ¤ˆ˜ 70% ÙˆÓ ÂÚÈÙÒÛˆÓ. √È Ulm Î·È Û˘Ó.14 _{ÌÂϤÙËÛ·Ó} ÙËÓ ˘fiıÂÛË fiÙÈ Ë ÚÒÈÌË ÂÓ‰ÔÌËÙÚÈ΋ ‰È¿-ÁÓˆÛË Â›Ó·È Èı·ÓfiÙÂÚÔ Ó· Û˘Óԉ‡ÂÙ·È Ì ÈÔ ÊÙˆ¯‹ ÚfiÁÓˆÛË. °È· ÙÔ ÛÎÔfi ·˘Ùfi Âͤ-Ù·Û·Ó ÛÂÈÚ¤˜ Ì ۇÁ¯ÚÔÓË ‰ÔÌÈ΋ Î·È ¯ÚˆÌÔ-ۈ̷ÙÈ΋ ·ÓˆÌ·Ï›· Û ¤Ì‚Ú˘· Ì Dandy Walker ‹ ·Ú·ÏÏ·Á‹˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÚÈÓ ·fi ÙȘ 21 ‚‰ÔÌ¿‰Â˜ Ù˘ ·ËÛ˘ Û˘ÁÎÚÈÓfi-ÌÂÓ˜ Ì ¤Ì‚Ú˘· Ì ‰È¿ÁÓˆÛË Dandy Walker ‹ ·Ú·ÏÏ·Á‹˜ ÙÔ˘, ÌÂٷ͇ 21 ‚‰ÔÌ¿‰ˆÓ Î·È ÙÔ˘ ÙÔÎÂÙÔ‡ . µÚ‹Î·Ó fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ Û˘-ÓÔ‰ÒÓ ˘ÂÚ˯ÔÁÚ·ÊÈο ‰È·ÈÛÙÔ˘Ì¤ÓˆÓ Â˘-ÚËÌ¿ÙˆÓ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ˘„Ë-ÏfiÙÂÚË ·Ó¿ÌÂÛ· Û ¤Ì‚Ú˘· Ì Dandy Walker Ô˘ ‰È·ÈÛÙÒıËΠÚÈÓ ÙȘ 21 ‚‰ÔÌ¿‰Â˜ Ù˘ ·ËÛ˘ ÂÓ Û¯¤ÛÂÈ Ì ·˘Ù‹ Ô˘ ‚Ú¤ıËΠ·ÚÁfi-ÙÂÚ· ÂÓ‰ÔÌËÙÚ›ˆ˜.(8 ·fi 14 Î·È 5 ·fi 14) Î·È ÔÈ ¯ÚˆÌÔۈ̷ÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ‹Ù·Ó ÛËÌ·ÓÙÈ-ο ÈÔ Û˘¯Ó¤˜ ÌÂٷ͇ ÂÌ‚Ú‡ˆÓ Ì ÚÒÈÌË ·Ó·ÁÓÒÚÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∏ ÎÏÈÓÈ΋ ÛËÌ·Û›· ÙˆÓ ·Ú·ÏÏ·ÁÒÓ ÙÔ˘ Û˘Ó-‰ÚfiÌÔ˘ ¤¯ÂÈ ÂÍÂÙ·ÛÙ› Ù· ÚÔËÁÔ‡ÌÂÓ· ¯Úfi-ÓÈ·. ™Â Ì›· ÌÂϤÙË ·fi ÙÔÓ Chang Î·È Û˘Ó.15 ÂÍÂÙ¿ÛÙËÎ·Ó Ù· ˘ÂÚ˯ÔÁÚ·Ê‹Ì·Ù· 65 ÂÌ-‚Ú‡ˆÓ Ì ·ÁÂÓÂÛ›· ÙÔ˘ ÛÎÒÏËη (37 ηÙÒÙÂ-ÚÔ˘ ÙÌ‹Ì·ÙÔ˜ ·ÁÂÓÂÛ›·,28 Ì Ï‹ÚË ·ÁÂÓÂÛ›·) ªfiÓÔÓ 22 ·fi Ù· 65 ¤Ì‚Ú˘· Â¤˙ËÛ·Ó Ì¤¯ÚÈ ÙÔÓ ÙÔÎÂÙfi Î·È 9 ·fi Ù· 22 ˙ÒÓÙ· ÓÂÔÁÓ¿ η٤-ÏËÍ·Ó Î·Ù¿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜ ÙÔ˘˜. ™˘ÓÔ‰¤˜ ·ÓˆÌ·Ï›Â˜ ‚ÚÂı‹Î·Ó Û 75% ÙˆÓ ÓÂÔ-ÁÓÒÓ Ì Ï‹ÚË ·ÁÂÓÂÛ›· ÙÔ˘ ÛÎÒÏËη Î·È Û 76% ÙˆÓ ÓÂÔÁÓÒÓ Ì ˘ÔÏ·Û›· ÙÔ˘ ηÙÒÙÂ-ÚÔ˘ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÛÎÒÏËη. ∫·Ú˘ÔÙ˘ÈΤ˜

·ÓˆÌ·Ï›Â˜ ‚ÚÂı‹Î·Ó Û 32% ÙˆÓ ÂÌ‚Ú‡ˆÓ Ì Ï‹ÚË ·ÁÂÓÂÛ›· ÙÔ˘ ÛÎÒÏËη Î·È 53% Û ¤Ì-‚Ú˘· Ì ·Ï·Û›· ÙÔ˘ ηÙÒÙÂÚÔ˘ ÙÌ‹Ì·ÙÔ˜. √È ÈÔ Û˘¯Ó¤˜ ¯ÚˆÌÔۈ̷ÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ‹Ù·Ó ÙÚÈۈ̛· 13, 21 Î·È 18. ∂¯ÂÈ Â›Û˘ ÂÚÈÁÚ·Ê› Ë ÔÈÎÔÁÂÓ‹˜ ·ÁÂÓÂÛ›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ (™‡Ó‰ÚÔÌÔ Joubert). ∏ ÔÈÎÔÁÂÓ‹˜ ·ÁÂÓÂÛ›· ÙÔ˘ ÛÎÒÏËη Û˘Óԉ‡ÂÙ·È Ì ÂÂÈÛfi‰È· ˘ÂÚηÓ›·˜, ·ıÔ-ÏÔÁÈΤ˜ ÎÈÓ‹ÛÂȘ ÙˆÓ ÔÊı·ÏÌÒÓ, ·Ù·Í›·, ÓÔËÙÈ-΋ ηı˘ÛÙ¤ÚËÛË Î·È ÎÏËÚÔÓÔÌÂ›Ù·È Ì ·˘ÙÔ-ۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ÙÚfiÔ.16 ™Â Ì›· ÔÈÎÔÁ¤ÓÂÈ· ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘, ÏfiÁˆ ÈÛÙÔÚÈÎÔ‡, ‰È·ÙÂٷ̤ÓË ÌÂÁ¿ÏË ‰ÂÍ·ÌÂÓ‹ ‚Ú¤-ıËΠÛÙȘ 25 ‚‰ÔÌ¿‰Â˜ Ù˘ ·ËÛ˘, ÂÓÒ ÔÏ-Ï·Ϥ˜ ÂÍÂÙ¿ÛÂȘ ÓˆÚ›ÙÂÚ· ÛÙËÓ Î‡ËÛË ‰ÂÓ ‹Ù·Ó ‰È·ÁÓˆÛÙÈΤ˜.17,18 Èڛ˜ ÔÈÎÔÁÂÓ¤˜ ÈÛÙÔÚÈÎfi ÙÔ Û‡Ó‰ÚÔÌÔ Joubert ‰ÂÓ ÌÔÚ› Ó· ‰È·ÎÚÈı› ˘ÂÚ˯ÔÁÚ·-ÊÈο ·fi ÌÂÌÔӈ̤ÓË Dandy Walker ‰È·Ù·Ú·-¯‹. ∏ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Á›ÓÂÙ·È Ì ÂÈ-ÛÎfiËÛË ÙˆÓ ·ÚÂÁÎÂÊ·ÏȉÈÎÒÓ ËÌÈÛÊ·ÈÚ›ˆÓ Î·È Ù˘ ÌÂÁ¿Ï˘ ‰ÂÍ·ÌÂÓ‹˜, ·ÍÈÔÏÔÁÒÓÙ·˜ ÙË Û˘ÌÌÂÙÚ›· ÙÔ˘˜ Î·È Û˘ÁÎÚ›ÓÔÓÙ·˜ ÙȘ ÌÂÙÚ‹ÛÂȘ ÙÔ˘˜ Ì ηıÔÚÈṲ̂ӷ ÓÔÌÔÁÚ¿ÌÌ·Ù·. ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È fiÙ·Ó ·Ó¢ڛÛÎÂÙ·È Ì›· ·ÛÙË ÙÔ˘ ÔÈÛı›Ô˘ ‚fiıÚÔ˘ ·fi ·Ú·¯ÓÔÂȉ‹ ·ÛÙË.19 ª›· ÔÈÛıÔ·ÚÂÁÎÂÊ·ÏȉÈ΋ ·Ú·¯ÓÔÂȉ‹˜ ·ÛÙË Â›Ó·È ÏÈÁfiÙÂÚÔ Û˘¯Ó‹ Î·È ÈÔ ‹È· ·Óˆ-Ì·Ï›· ·fi ÙÔ Û‡Ó‰ÚÔÌÔ Dandy Walker, ‰ÈfiÙÈ ÛÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ Ô ˘ÔΛÌÂÓÔ˜ ÂÁΤʷ-ÏÔ˜ Â›Ó·È Û¯ËÌ·ÙÈṲ̂ÓÔ˜ Ê˘ÛÈÔÏÔÁÈο. ∞˘Ù‹ Ë ‚Ï¿‚Ë ¿ÓÙ· ‰ËÌÈÔ˘ÚÁ› ¤Ó· ÈÂÛÙÈÎfi Ê·È-ÓfiÌÂÓÔ ·ÏÏ¿ Û ·ÓÙ›ıÂÛË Ì ÙËÓ Î˘ÛÙÈ΋ Ì¿-˙· Ô˘ ‰È·¯ˆÚ›˙ÂÈ Ù· ·ÚÂÁÎÂÊ·ÏȉÈο ËÌÈ-ÛÊ·›ÚÈ· ÛÙÔ Û‡Ó‰ÚÔÌÔ Dandy Walker Ë ·Ú·-¯ÓÔÂȉ‹˜ ·ÛÙË Ù· ÌÂÙ·ÙÔ›˙ÂÈ Û˘ÓÔÏÈο. ªÈ· Ù¤ÙÔÈ· Ì¿˙· ı· ·Ó˘„ÒÛÂÈ Â›Û˘ ÙÔ ÛÎËÓ›‰ÈÔ. ŒÙÛÈ ·˘Ùfi ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ‰ÂÓ ÌÔÚ› Ó· Â›Ó·È ‰È·ÊÔÚԉȷÁÓˆÛÙÈÎfi. ∂›Ó·È ÛËÌ·ÓÙÈÎfi ÛÙËÓ ÂÎÙ›ÌËÛË ÂÓfi˜ ÂÌ‚Ú‡Ô˘ Ì ·ÛÙË ÙÔ˘ Ô›ÛıÈÔ˘ ‚fiıÚÔ˘ Ó· ÂÏÂÁ¯ıÔ‡Ó ÚÔÛÂÎÙÈο ÔÈ ‰Ô̤˜ Ù˘ ̤Û˘ ÁÚ·ÌÌ‹˜ ¿ÓˆıÂÓ ÙÔ˘ ÛÎË-Óȉ›Ô˘.20_{Ÿˆ˜ ¤¯ÂÈ ÛËÌÂȈı› ÓˆÚ›ÙÂÚ·,} ÎÔÈ-ÏÈÔÌÂÁ·Ï›· ÌÔÚ› Ó· ·ÚÔ˘ÛÈ·ÛÙ› Î·È Ó· ·ÔÙÂÏ› ·ÏËı‹ ˘‰ÚÔΤʷÏÔ ‹ ÎÔÏÔÎÂÊ·Ï›· Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ·ÁÂÓÂÛ›· ÙÔ˘ ÌÂÛÔÏÔ‚›-Ô˘. ¶Ú¤ÂÈ Ó· ·Ó·˙ËÙËıÔ‡Ó ÛÙÔȯ›· ˘ÂÚË-¯ÔÁÚ·ÊÈο Ù˘ ·ÁÂÓÂÛ›·˜ ÙÔ˘ ÌÂÛÔÏÔ‚›Ô˘. ªÂÁ¿ÏË ÔÈÛıÔ·ÚÂÁÎÂÊ·ÏȉÈ΋ ·Ú·¯ÓÔÂÈ-‰‹˜ ·ÛÙË ÌÔÚ› Ó· ÚÔηϤÛÂÈ ‰È¿Ù·ÛË ÙˆÓ ÎÔÈÏÈÒÓ ·fi Û˘Ì›ÂÛË ·ÏÏ¿ ÔÈ Î‡ÛÙÂȘ ·˘Ù¤˜ ‰ÂÓ Û˘Óԉ‡ÔÓÙ·È Ì ·ÁÂÓÂÛ›· ÙÔ˘ ÌÂÛÔÏfi‚È-Ô˘ ‹ ÎÔÏÔÎÂÊ·Ï›·. ∞ӈ̷ϛ· Arnold – Chiari ∏ ·ÓˆÌ·Ï›· Arnold-Chiari Â›Ó·È ·ÓˆÌ·Ï›· ÙÔ˘ Ô›ÛıÈÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi ‰‡Ô ÛΤÏË. ∆Ô ÚÒÙÔ Â›Ó·È ‰È·ÊfiÚÔ˘ ‚·ıÌÔ‡ ÌÂÙ·ÙfiÈÛË ÈÛÙÔ‡ Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ Î·ÙÒÙÂÚÔ ÙÌ‹Ì· ÙÔ˘ ÛÎÒÏËη Ù˘ ·-ÚÂÁÎÂÊ·Ï›‰·˜ ̤۷ ÛÙÔ ·ÓÒÙÂÚÔ ÛÔÓ‰˘ÏÈÎfi ÙÚ‹Ì·. ∆Ô ‰Â‡ÙÂÚÔ Â›Ó·È Ì›· fiÌÔÈ· Ô˘Ú·›· ÌÂÙ·ÙfiÈÛË Ù˘ Á¤Ê˘Ú·˜, Ù˘ ٤ٷÚÙ˘ ÎÔÈ-Ï›·˜ Î·È ÙÔ˘ ÚÔÌ‹ÎË Ì˘ÂÏÔ‡ ‰È·Ì¤ÛÔ˘ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ÙÚ‹Ì·ÙÔ˜ ̤۷ ÛÙÔ ÛÔÓ‰˘ÏÈÎfi ·˘-Ïfi. ∞˘Ùfi Û˘Ó‹ıˆ˜ Û˘Óԉ‡ÂÙ·È Ì ˘‰ÚÔΤʷ-ÏÔ Î·È ÌËÓÓÈÁÁÔÌ˘Â˘‰ÚÔΤʷ-ÏÔ΋ÏË.21 _{∞ӷʤÚÂÙ·È fiÙÈ} ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ‰Èۯȉԇ˜ Ú¿-¯Ë˜ ÂÈϤÎÔÓÙ·È ·fi ÙËÓ ‰È·Ù·Ú·¯‹ Arnold Chiari Î·È fiÙÈ 90 ¤ˆ˜ 95% ·˘ÙÒÓ ÙˆÓ ·ÛıÂ-ÓÒÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘‰ÚÔΤʷÏÔ.22,23 _∏ ‰È·Ù·-Ú·¯‹ Arnold Chiari ·ÔÙÂÏ› ¤Ó·Ó ÛËÌ·ÓÙÈÎfi ‰Â›ÎÙË ÁÈ· ÙË ‰Èۯȉ‹ Ú¿¯Ë. ¢‡Ô ·ıÔÁÓˆÌÈ-ο ˘ÂÚ˯ÔÁÚ·ÊÈ·ıÔÁÓˆÌÈ-ο ÛËÌ›· ¤¯Ô˘Ó ÂÚÈÁÚ·-Ê› ÁÈ· ÙË ‰È·Ù·Ú·¯‹ Arnold Chiari Î·È Â›Ó·È ÙÔ ÛËÌÂ›Ô ÙÔ˘ ÏÂÌÔÓÈÔ‡ fiÔ˘ ÂÌ‚¿ı˘ÓÛË ÙˆÓ ÌÂÙˆÈ·›ˆÓ ÔÛÙÒÓ ÌÔÚ› Ó· ‰ÒÛÂÈ Ì›· Û¯‹-Ì·ÙÔ˜ ÏÂÌÔÓÈÔ‡ ‰È·ÌfiÚʈÛË ÛÙÔ ÎÚ·Ó›Ô ÙÔ˘ ÚÔۂ‚ÏË̤ÓÔ˘ ÂÌ‚Ú‡Ô˘ Û ÂÁοÚÛÈ· ÙÔÌ‹ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‰Â˘Ù¤ÚÔ˘ ÙÚÈÌ‹ÓÔ˘. ∏ Ô˘-Ú·›· ÌÂÙ·ÙfiÈÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÈÛÙÔ‡ Ê·›-ÓÂÙ·È Ó· ·Ú¿ÁÂÈ ·˘Ù‹ ÙËÓ ÂÌ‚¿ı˘ÓÛË. ∏ ÌÂ-Ù·ÙfiÈÛË Ù˘ ·ÚÂÁÎÂÊ·Ï›‰Ô˜ ·Ú·ÌÔÚÊÒ-ÓÂÈ Ù· ËÌÈÛÊ·›ÚÈ· Ù˘ (Ù· ÔÔ›· ¯¿ÓÔ˘Ó ÙÔ ÛÊ·ÈÚÈÎfi ÙÔ˘˜ Û¯‹Ì·) Á›ÓÔÓÙ·È Â›‰·, Ë ÌÂ-Á¿ÏË ‰ÂÍ·ÌÂÓ‹ Û˘ÌȤ˙ÂÙ·È Î·È ÙÔ ÂÓÙ‡ˆÌ· ÙÔ˘ ÛÎÒÏËη Ê·›ÓÂÙ·È ÂÚÈÛÛfiÙÂÚÔ Û˘Ó¯¤˜ Î·È ÚÔ·ÙÂÈ ÙÔ ÛËÌÂ›Ô Ù˘ Ì·Ó¿Ó·˜, ÙÔ ÔÔ›Ô ÌÔÚ› Ó· Ê·Ó› ·fi ÙÔ ÚÒÙÔ ÙÚ›ÌË-ÓÔ.24 _{™Â ·ÎÚ·›Â˜ ÂÚÈÙÒÛÂȘ Ù·} ·ÚÂÁÎÂÊ·-ÏȉÈο ËÌÈÛÊ·›ÚÈ· ÌÔÚ› Ó· ÌËÓ ÂÌÊ·Ó›˙Ô-ÓÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ˘ÂÚ˯ÔÁÚ·ÊÈÎÔ‡ ÂϤÁ¯Ô˘ Ù˘ ÎÂÊ·Ï‹˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘. ∞˘Ù‹ Ë ¯·Ú·ÎÙËÚÈÛÙÈ΋ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂÌÊ¿ÓÈÛË

Ú¤ÂÈ Ó· ÎÈÓËÙÔÔÈ‹ÛÂÈ ÙÔÓ ˘ÂÚ˯ÔÁÚ·ÊÈ-ÛÙ‹ ÁÈ· Ó· „¿ÍÂÈ ÁÈ· ‰Èۯȉ‹ Ú¿¯Ë.25-28

Posterior fossa abnormalities –

Dandy Walker Syndrome

Ch. ∫allideri, D. ∫assanos, ∂. ™alamalekis

3rd Department of Obstetrics and Gynaecology, University of Athens P.G.N. ”Attikon”, Athens, Greece AÏÏËÏÔÁÚ·Ê›·: D. Kassanos

1 Rimini str., 12462 Chaidari, Greece ∆el.: 210-5831000, direct: 2214 E-mail: [email protected]

Summary

Dandy Walker syndrome indicates the associ-ation of 1) ventriculomegaly of variable de-gree 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, (en-larged posterior fossa, complete or partial agenesis of the cerebellar vermis and elevated tentorium) 2) the Dandy Walker variant (vari-able 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 iso-lated Dandy Walker malformation.

The Arnold Chiari malformation is an anom-aly of the hindbrain, with two components. The first a variable displacement of tissue

de-rived from the inferior cerebellar vermis into the upper cervical canal. The second a similar caudal dislocation of the pons, the fourth ven-tricleand mededulla oblonganda to the spinal canal. Usually is associated with hydro-cephalus and spina bifida.

Key words: Dandy Walker syndrome, abnormalities of the

ver-mis, enlargement of the fourth ventricle

µÈ‚ÏÈÔÁÚ·Ê›·

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