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C1 arch regeneration, tight cisterna magna, and cervical syringomyelia following foramen magnum surgery.
Surg Neurol. 2009 Jul; 72(1):83-5; discussion 85-6.SN

Abstract

BACKGROUND

Although bone regrowth following craniocervical decompression has been rarely reported to cause late recurrence of Chiari symptoms, syringomyelia has not been observed in such cases. We report a unique case of cervical syringomyelia resulting from spontaneous regeneration of the posterior C1 arch after foramen magnum decompression.

CASE DESCRIPTION

A 38-year-old male patient underwent resection of a symptomatic foramen magnum meningioma. Three years later, he developed neuropathic pain in his left upper extremity with worsening dysphagia and dysphonia. MRI revealed regeneration of the posterior arch of C1 with tight tonsillar impaction of the foramen magnum and extensive cervical syringomyelia. Surgical exploration was undertaken. Neo-ossification of the posterior arch of C1 and thick arachnoid adhesions were found to obstruct cerebrospinal fluid flow through the foramen of Magendie. Foramen magnum decompression, arachnoid dissection, and duraplasty were thus performed and cerebrospinal fluid flow was reestablished through the foramen of Magendie. Postoperatively, patient's symptoms improved dramatically and repeat MRI showed complete resolution of the syrinx cavity.

CONCLUSION

Spontaneous bone regrowth and arachnoid scarring may lead to the development of cervical syringomyelia several years after foramen magnum surgery. Neurosurgeons should be aware of this rare complication whose management is similar to that of Chiari malformations, namely craniocervical decompression and establishment of a patent foramen of Magendie.

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Authors+Show Affiliations

Rahme R
Department of Neurosurgery, Saint Joseph University and Hôtel-Dieu de France, Beirut, Lebanon.
Koussa S
No affiliation info available
Samaha E
No affiliation info available

MeSH

AdultArachnoidCerebrospinal FluidCervical AtlasCranial Fossa, PosteriorDecompression, SurgicalDeglutition DisordersForamen MagnumHumansMagnetic Resonance ImagingMaleMeningeal NeoplasmsMeningiomaOssification, HeterotopicPostoperative ComplicationsRadiculopathyReoperationSkull Base NeoplasmsSpinal CordSubarachnoid SpaceSyringomyeliaTissue AdhesionsTreatment Outcome

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

18440624

Citation

Rahme, Ralph, et al. "C1 Arch Regeneration, Tight Cisterna Magna, and Cervical Syringomyelia Following Foramen Magnum Surgery." Surgical Neurology, vol. 72, no. 1, 2009, pp. 83-5; discussion 85-6.
Rahme R, Koussa S, Samaha E. C1 arch regeneration, tight cisterna magna, and cervical syringomyelia following foramen magnum surgery. Surg Neurol. 2009;72(1):83-5; discussion 85-6.
Rahme, R., Koussa, S., & Samaha, E. (2009). C1 arch regeneration, tight cisterna magna, and cervical syringomyelia following foramen magnum surgery. Surgical Neurology, 72(1), 83-5; discussion 85-6. https://doi.org/10.1016/j.surneu.2008.01.041
Rahme R, Koussa S, Samaha E. C1 Arch Regeneration, Tight Cisterna Magna, and Cervical Syringomyelia Following Foramen Magnum Surgery. Surg Neurol. 2009;72(1):83-5; discussion 85-6. PubMed PMID: 18440624.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - C1 arch regeneration, tight cisterna magna, and cervical syringomyelia following foramen magnum surgery. AU - Rahme,Ralph, AU - Koussa,Salam, AU - Samaha,Elie, Y1 - 2008/04/28/ PY - 2007/12/01/received PY - 2008/01/07/accepted PY - 2008/4/29/pubmed PY - 2009/8/18/medline PY - 2008/4/29/entrez SP - 83-5; discussion 85-6 JF - Surgical neurology JO - Surg Neurol VL - 72 IS - 1 N2 - BACKGROUND: Although bone regrowth following craniocervical decompression has been rarely reported to cause late recurrence of Chiari symptoms, syringomyelia has not been observed in such cases. We report a unique case of cervical syringomyelia resulting from spontaneous regeneration of the posterior C1 arch after foramen magnum decompression. CASE DESCRIPTION: A 38-year-old male patient underwent resection of a symptomatic foramen magnum meningioma. Three years later, he developed neuropathic pain in his left upper extremity with worsening dysphagia and dysphonia. MRI revealed regeneration of the posterior arch of C1 with tight tonsillar impaction of the foramen magnum and extensive cervical syringomyelia. Surgical exploration was undertaken. Neo-ossification of the posterior arch of C1 and thick arachnoid adhesions were found to obstruct cerebrospinal fluid flow through the foramen of Magendie. Foramen magnum decompression, arachnoid dissection, and duraplasty were thus performed and cerebrospinal fluid flow was reestablished through the foramen of Magendie. Postoperatively, patient's symptoms improved dramatically and repeat MRI showed complete resolution of the syrinx cavity. CONCLUSION: Spontaneous bone regrowth and arachnoid scarring may lead to the development of cervical syringomyelia several years after foramen magnum surgery. Neurosurgeons should be aware of this rare complication whose management is similar to that of Chiari malformations, namely craniocervical decompression and establishment of a patent foramen of Magendie. SN - 1879-3339 UR - https://www.unboundmedicine.com/medline/citation/18440624/C1_arch_regeneration_tight_cisterna_magna_and_cervical_syringomyelia_following_foramen_magnum_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-3019(08)00056-6 DB - PRIME DP - Unbound Medicine ER -