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Intraoperative somatosensory evoked potential recovery following opening of the fourth ventricle during posterior fossa decompression in Chiari malformation: case report.
J Neurosurg. 2015 Mar; 122(3):692-6.JN

Abstract

The most appropriate surgical technique for posterior fossa decompression in Chiari malformation (CM) remains a matter of debate. Intraoperative electrophysiological studies during posterior fossa decompression of Type I CM (CM-I) aim to shed light on the entity's pathomechanism as well as on the ideal extent of decompression. The existing reports on this issue state that significant improvement in conduction occurs after craniotomy in all cases, but additional durotomy contributes a further improvement in only a minority of cases. This implies that craniotomy alone might suffice for clinical improvement without the need of duraplasty or even subarachnoid manipulation at the level of the craniocervical junction. In contrast to published data, the authors describe the case of a 32-year-old woman who underwent surgery for CM associated with extensive cervicothoracic syringomyelia and whose intraoperative somatosensory evoked potentials (SSEPs) did not notably improve after craniotomy or following durotomy; rather, they only improved after opening of the fourth ventricle and restoration of CSF flow through the foramen of Magendie. Postoperatively, the patient recovered completely from her preoperative neurological deficits. To the authors' knowledge, this is the first report of significant SSEP recovery after opening the fourth ventricle in the decompression of a CM-I. The electrophysiological and operative techniques are described in detail and the findings are discussed in the light of available literature. The authors conclude that there might be a subset of CM-I patients who require subarachnoid dissection at the level of the craniocervical junction to benefit clinically. Prospective studies with detailed electrophysiological analyses seem warranted to answer the question regarding the best surgical approach in CM-I decompression.

Authors+Show Affiliations

Department of Neurosurgery, General Hospital of Klagenfurt, Austria.No affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

25526275

Citation

Grossauer, Stefan, et al. "Intraoperative Somatosensory Evoked Potential Recovery Following Opening of the Fourth Ventricle During Posterior Fossa Decompression in Chiari Malformation: Case Report." Journal of Neurosurgery, vol. 122, no. 3, 2015, pp. 692-6.
Grossauer S, Koeck K, Vince GH. Intraoperative somatosensory evoked potential recovery following opening of the fourth ventricle during posterior fossa decompression in Chiari malformation: case report. J Neurosurg. 2015;122(3):692-6.
Grossauer, S., Koeck, K., & Vince, G. H. (2015). Intraoperative somatosensory evoked potential recovery following opening of the fourth ventricle during posterior fossa decompression in Chiari malformation: case report. Journal of Neurosurgery, 122(3), 692-6. https://doi.org/10.3171/2014.10.JNS14401
Grossauer S, Koeck K, Vince GH. Intraoperative Somatosensory Evoked Potential Recovery Following Opening of the Fourth Ventricle During Posterior Fossa Decompression in Chiari Malformation: Case Report. J Neurosurg. 2015;122(3):692-6. PubMed PMID: 25526275.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraoperative somatosensory evoked potential recovery following opening of the fourth ventricle during posterior fossa decompression in Chiari malformation: case report. AU - Grossauer,Stefan, AU - Koeck,Katharina, AU - Vince,Giles H, Y1 - 2014/12/19/ PY - 2014/12/20/entrez PY - 2014/12/20/pubmed PY - 2015/4/22/medline KW - BAEP = brainstem auditory evoked potential KW - CM = Chiari malformation KW - CM-I = CM Type I KW - Chiari malformation KW - SSEP = somatosensory evoked potential KW - duraplasty KW - intraoperative neuromonitoring KW - posterior fossa KW - somatosensory evoked potentials SP - 692 EP - 6 JF - Journal of neurosurgery JO - J Neurosurg VL - 122 IS - 3 N2 - The most appropriate surgical technique for posterior fossa decompression in Chiari malformation (CM) remains a matter of debate. Intraoperative electrophysiological studies during posterior fossa decompression of Type I CM (CM-I) aim to shed light on the entity's pathomechanism as well as on the ideal extent of decompression. The existing reports on this issue state that significant improvement in conduction occurs after craniotomy in all cases, but additional durotomy contributes a further improvement in only a minority of cases. This implies that craniotomy alone might suffice for clinical improvement without the need of duraplasty or even subarachnoid manipulation at the level of the craniocervical junction. In contrast to published data, the authors describe the case of a 32-year-old woman who underwent surgery for CM associated with extensive cervicothoracic syringomyelia and whose intraoperative somatosensory evoked potentials (SSEPs) did not notably improve after craniotomy or following durotomy; rather, they only improved after opening of the fourth ventricle and restoration of CSF flow through the foramen of Magendie. Postoperatively, the patient recovered completely from her preoperative neurological deficits. To the authors' knowledge, this is the first report of significant SSEP recovery after opening the fourth ventricle in the decompression of a CM-I. The electrophysiological and operative techniques are described in detail and the findings are discussed in the light of available literature. The authors conclude that there might be a subset of CM-I patients who require subarachnoid dissection at the level of the craniocervical junction to benefit clinically. Prospective studies with detailed electrophysiological analyses seem warranted to answer the question regarding the best surgical approach in CM-I decompression. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/25526275/Intraoperative_somatosensory_evoked_potential_recovery_following_opening_of_the_fourth_ventricle_during_posterior_fossa_decompression_in_Chiari_malformation:_case_report_ L2 - https://thejns.org/doi/10.3171/2014.10.JNS14401 DB - PRIME DP - Unbound Medicine ER -