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Raised intracranial pressure and hydrocephalus following hindbrain decompression for Chiari I malformation: a case series and review of the literature.
Br J Neurosurg. 2012 Aug; 26(4):476-81.BJ

Abstract

OBJECT

Chiari-syringomyelia is a heterogeneous condition that may be treated by decompression of the foramen magnum. Raised intracranial pressure (ICP) and/or hydrocephalus is a rare complication of this treatment. We aim to describe the incidence, clinical presentation, radiographic findings, management and outcome of patients developing raised ICP and/or hydrocephalus after hindbrain decompression for Chiari I malformation.

METHODS

Retrospective analysis of 138 consecutive adult and paediatric patients with Chiari I malformation who underwent foramen magnum decompression.

RESULTS

The incidence of post-operative symptomatic raised ICP and/or hydrocephalus in this series was 8.7%. Overall, 9 of 12 patients developing raised ICP or hydrocephalus required a VP shunt, an overall incidence of 6.5%. However, 3 of 12 patients were successfully managed with external ventricular drainage or conservatively. Presentation was with headache or CSF wound leak at a median of 13 days post-operatively. Subdural hygromata were observed in five cases in association with hydrocephalus and urgent drainage to relieve mass effect was required in two cases. At a mean follow up of 36 months, 9 of 12 patients were asymptomatic.

CONCLUSIONS

There is a risk of requiring a permanent VP shunt associated with decompression for Chiari I even in the absence of ventriculomegaly or signs of raised ICP pre-operatively. Patients presenting with new symptoms or CSF wound leak following FMD mandate investigation to exclude hydrocephalus, raised ICP or subdural hygroma.

Authors+Show Affiliations

Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, UK. rzakaria@nhs.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22280544

Citation

Zakaria, Rasheed, et al. "Raised Intracranial Pressure and Hydrocephalus Following Hindbrain Decompression for Chiari I Malformation: a Case Series and Review of the Literature." British Journal of Neurosurgery, vol. 26, no. 4, 2012, pp. 476-81.
Zakaria R, Kandasamy J, Khan Y, et al. Raised intracranial pressure and hydrocephalus following hindbrain decompression for Chiari I malformation: a case series and review of the literature. Br J Neurosurg. 2012;26(4):476-81.
Zakaria, R., Kandasamy, J., Khan, Y., Jenkinson, M. D., Hall, S. R., Brodbelt, A., Pigott, T., & Mallucci, C. L. (2012). Raised intracranial pressure and hydrocephalus following hindbrain decompression for Chiari I malformation: a case series and review of the literature. British Journal of Neurosurgery, 26(4), 476-81. https://doi.org/10.3109/02688697.2011.650738
Zakaria R, et al. Raised Intracranial Pressure and Hydrocephalus Following Hindbrain Decompression for Chiari I Malformation: a Case Series and Review of the Literature. Br J Neurosurg. 2012;26(4):476-81. PubMed PMID: 22280544.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Raised intracranial pressure and hydrocephalus following hindbrain decompression for Chiari I malformation: a case series and review of the literature. AU - Zakaria,Rasheed, AU - Kandasamy,Jothy, AU - Khan,Yousaf, AU - Jenkinson,Michael D, AU - Hall,Sam R, AU - Brodbelt,Andrew, AU - Pigott,Tim, AU - Mallucci,Conor L, Y1 - 2012/01/27/ PY - 2012/1/28/entrez PY - 2012/1/28/pubmed PY - 2012/12/10/medline SP - 476 EP - 81 JF - British journal of neurosurgery JO - Br J Neurosurg VL - 26 IS - 4 N2 - OBJECT: Chiari-syringomyelia is a heterogeneous condition that may be treated by decompression of the foramen magnum. Raised intracranial pressure (ICP) and/or hydrocephalus is a rare complication of this treatment. We aim to describe the incidence, clinical presentation, radiographic findings, management and outcome of patients developing raised ICP and/or hydrocephalus after hindbrain decompression for Chiari I malformation. METHODS: Retrospective analysis of 138 consecutive adult and paediatric patients with Chiari I malformation who underwent foramen magnum decompression. RESULTS: The incidence of post-operative symptomatic raised ICP and/or hydrocephalus in this series was 8.7%. Overall, 9 of 12 patients developing raised ICP or hydrocephalus required a VP shunt, an overall incidence of 6.5%. However, 3 of 12 patients were successfully managed with external ventricular drainage or conservatively. Presentation was with headache or CSF wound leak at a median of 13 days post-operatively. Subdural hygromata were observed in five cases in association with hydrocephalus and urgent drainage to relieve mass effect was required in two cases. At a mean follow up of 36 months, 9 of 12 patients were asymptomatic. CONCLUSIONS: There is a risk of requiring a permanent VP shunt associated with decompression for Chiari I even in the absence of ventriculomegaly or signs of raised ICP pre-operatively. Patients presenting with new symptoms or CSF wound leak following FMD mandate investigation to exclude hydrocephalus, raised ICP or subdural hygroma. SN - 1360-046X UR - https://www.unboundmedicine.com/medline/citation/22280544/Raised_intracranial_pressure_and_hydrocephalus_following_hindbrain_decompression_for_Chiari_I_malformation:_a_case_series_and_review_of_the_literature_ DB - PRIME DP - Unbound Medicine ER -