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Chiari I malformation: a rare cause of noncommunicating hydrocephalus treated by third ventriculostomy.
J Neurosurg. 2001 Nov; 95(5):783-90.JN

Abstract

OBJECT

Hydrocephalus associated with Chiari I malformation is a rare entity related to an obstruction in the flow of cerebrospinal fluid (CSF) in the foramen of Magendie. Like all forms of noncommunicating hydrocephalus. it can be treated by endoscopic third ventriculostomy (ETV). The object of this study is to report a series of five cases of hydrocephalus associated with Chiari I malformation and to evaluate the use of ETV in the treatment of this anomaly.

METHODS

Five patients (four women and one man with a mean age of 29.6 years) underwent ETV for hydrocephalus associated with Chiari I malformation between April 1991 and February 1997. All patients had presented with paroxysmal headaches, which in two cases were associated with visual disorders. All patients had also presented with hydrocephalus (mean transverse diameter of the third ventricle 12.79 mm; mean sagittal diameter of the fourth ventricle 18.27 mm) with a mean herniation of the cerebellar tonsils at 13.75 mm below the basion-opisthion line. Surgery was performed in all patients by using a rigid endoscope. No complications occurred either during or after the procedure, except in one patient who experienced a wound infection that was treated by antibiotic medications. The mean duration of follow up in this study was 50.39 months. Four patients became completely asymptomatic and remained stable throughout the follow-up period. One patient required an additional third ventriculostomy after I year, due to secondary closure, and has remained stable since that time. Postoperative magnetic resonance images demonstrated a significant reduction in the extent of hydrocephalus in all patients (mean transverse diameter of the third ventricle 6.9 mm [p = 0.0035]; mean sagittal diameter of the fourth ventricle 10.32 mm [p = 0.007]), with a mean ascent of the cerebellar tonsils from 13.75 mm below the basion-opisthion line to 7.76 mm below it (p = 0.01). In addition, CSF flow was identified on either side of the orifice of the third ventriculostomy in all patients postoperatively.

CONCLUSIONS

Results in this series confirm the efficacy of ETV in the treatment of hydrocephalus associated with Chiari I malformation. It is a reliable, minimally invasive technique that also provides a better understanding of the pathophysiology of this malformation.

Authors+Show Affiliations

Service de Neurochirurgie et de Neuroradiologie, Hôpital Henri Mondor, Créteil, France. philippe.decq@hmn.ap-hop-paris.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11702868

Citation

Decq, P, et al. "Chiari I Malformation: a Rare Cause of Noncommunicating Hydrocephalus Treated By Third Ventriculostomy." Journal of Neurosurgery, vol. 95, no. 5, 2001, pp. 783-90.
Decq P, Le Guérinel C, Sol JC, et al. Chiari I malformation: a rare cause of noncommunicating hydrocephalus treated by third ventriculostomy. J Neurosurg. 2001;95(5):783-90.
Decq, P., Le Guérinel, C., Sol, J. C., Brugières, P., Djindjian, M., & Nguyen, J. P. (2001). Chiari I malformation: a rare cause of noncommunicating hydrocephalus treated by third ventriculostomy. Journal of Neurosurgery, 95(5), 783-90.
Decq P, et al. Chiari I Malformation: a Rare Cause of Noncommunicating Hydrocephalus Treated By Third Ventriculostomy. J Neurosurg. 2001;95(5):783-90. PubMed PMID: 11702868.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chiari I malformation: a rare cause of noncommunicating hydrocephalus treated by third ventriculostomy. AU - Decq,P, AU - Le Guérinel,C, AU - Sol,J C, AU - Brugières,P, AU - Djindjian,M, AU - Nguyen,J P, PY - 2001/11/13/pubmed PY - 2002/1/5/medline PY - 2001/11/13/entrez SP - 783 EP - 90 JF - Journal of neurosurgery JO - J Neurosurg VL - 95 IS - 5 N2 - OBJECT: Hydrocephalus associated with Chiari I malformation is a rare entity related to an obstruction in the flow of cerebrospinal fluid (CSF) in the foramen of Magendie. Like all forms of noncommunicating hydrocephalus. it can be treated by endoscopic third ventriculostomy (ETV). The object of this study is to report a series of five cases of hydrocephalus associated with Chiari I malformation and to evaluate the use of ETV in the treatment of this anomaly. METHODS: Five patients (four women and one man with a mean age of 29.6 years) underwent ETV for hydrocephalus associated with Chiari I malformation between April 1991 and February 1997. All patients had presented with paroxysmal headaches, which in two cases were associated with visual disorders. All patients had also presented with hydrocephalus (mean transverse diameter of the third ventricle 12.79 mm; mean sagittal diameter of the fourth ventricle 18.27 mm) with a mean herniation of the cerebellar tonsils at 13.75 mm below the basion-opisthion line. Surgery was performed in all patients by using a rigid endoscope. No complications occurred either during or after the procedure, except in one patient who experienced a wound infection that was treated by antibiotic medications. The mean duration of follow up in this study was 50.39 months. Four patients became completely asymptomatic and remained stable throughout the follow-up period. One patient required an additional third ventriculostomy after I year, due to secondary closure, and has remained stable since that time. Postoperative magnetic resonance images demonstrated a significant reduction in the extent of hydrocephalus in all patients (mean transverse diameter of the third ventricle 6.9 mm [p = 0.0035]; mean sagittal diameter of the fourth ventricle 10.32 mm [p = 0.007]), with a mean ascent of the cerebellar tonsils from 13.75 mm below the basion-opisthion line to 7.76 mm below it (p = 0.01). In addition, CSF flow was identified on either side of the orifice of the third ventriculostomy in all patients postoperatively. CONCLUSIONS: Results in this series confirm the efficacy of ETV in the treatment of hydrocephalus associated with Chiari I malformation. It is a reliable, minimally invasive technique that also provides a better understanding of the pathophysiology of this malformation. SN - 0022-3085 UR - https://www.unboundmedicine.com/medline/citation/11702868/Chiari_I_malformation:_a_rare_cause_of_noncommunicating_hydrocephalus_treated_by_third_ventriculostomy_ L2 - https://thejns.org/doi/10.3171/jns.2001.95.5.0783 DB - PRIME DP - Unbound Medicine ER -