Tags

Type your tag names separated by a space and hit enter

Posterior Calvarial Augmentation for Chiari Malformation Type 1 Refractory to Foramen Magnum Decompression.
World Neurosurg. 2020 07; 139:70-74.WN

Abstract

BACKGROUND

Chiari 1 malformation is a structural abnormality of the hindbrain and posterior fossa characterized by herniation of the cerebellar tonsils through the foramen magnum. Although asymptomatic in some cases, hindbrain herniation can be associated with disruption of cerebrospinal fluid flow dynamics at the craniovertebral junction and syrinx formation, leading to symptoms. Foramen magnum decompression with or without duraplasty has been the most commonly performed surgical procedure in the management of this condition. The management of syringomyelia associated with Chiari malformation is more challenging and controversial. Although the associated syrinx can significantly improve after craniovertebral decompression and restoration of cerebrospinal fluid flow, in some cases, it will persist despite decompressive surgery and could even continue to enlarge.

CASE DESCRIPTION

We have described the case of a 4-year-old boy with non-craniosynostotic Chiari malformation and extensive cervical syrinx who, despite foramen magnum decompression and further revision, continued to deteriorate clinically and radiologically. Posterior calvarial augmentation was performed as a salvage procedure, with resolution of the tonsillar herniation and syrinx.

CONCLUSIONS

Posterior calvarial augmentation is a viable option for patients with Chiari malformation refractory to foramen magnum decompression.

Authors+Show Affiliations

Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, United Kingdom. Electronic address: afsharifardad@googlemail.com.Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, United Kingdom.Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, United Kingdom.Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, United Kingdom.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32298820

Citation

Afshari, Fardad T., et al. "Posterior Calvarial Augmentation for Chiari Malformation Type 1 Refractory to Foramen Magnum Decompression." World Neurosurgery, vol. 139, 2020, pp. 70-74.
Afshari FT, Solanki GA, Lo WB, et al. Posterior Calvarial Augmentation for Chiari Malformation Type 1 Refractory to Foramen Magnum Decompression. World Neurosurg. 2020;139:70-74.
Afshari, F. T., Solanki, G. A., Lo, W. B., & Rodrigues, D. (2020). Posterior Calvarial Augmentation for Chiari Malformation Type 1 Refractory to Foramen Magnum Decompression. World Neurosurgery, 139, 70-74. https://doi.org/10.1016/j.wneu.2020.03.218
Afshari FT, et al. Posterior Calvarial Augmentation for Chiari Malformation Type 1 Refractory to Foramen Magnum Decompression. World Neurosurg. 2020;139:70-74. PubMed PMID: 32298820.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Posterior Calvarial Augmentation for Chiari Malformation Type 1 Refractory to Foramen Magnum Decompression. AU - Afshari,Fardad T, AU - Solanki,Guirish A, AU - Lo,William B, AU - Rodrigues,Desiderio, Y1 - 2020/04/13/ PY - 2020/02/26/received PY - 2020/03/28/revised PY - 2020/03/30/accepted PY - 2020/4/17/pubmed PY - 2020/9/8/medline PY - 2020/4/17/entrez KW - Chiari malformation KW - Foramen magnum decompression KW - Posterior calvarial augmentation SP - 70 EP - 74 JF - World neurosurgery JO - World Neurosurg VL - 139 N2 - BACKGROUND: Chiari 1 malformation is a structural abnormality of the hindbrain and posterior fossa characterized by herniation of the cerebellar tonsils through the foramen magnum. Although asymptomatic in some cases, hindbrain herniation can be associated with disruption of cerebrospinal fluid flow dynamics at the craniovertebral junction and syrinx formation, leading to symptoms. Foramen magnum decompression with or without duraplasty has been the most commonly performed surgical procedure in the management of this condition. The management of syringomyelia associated with Chiari malformation is more challenging and controversial. Although the associated syrinx can significantly improve after craniovertebral decompression and restoration of cerebrospinal fluid flow, in some cases, it will persist despite decompressive surgery and could even continue to enlarge. CASE DESCRIPTION: We have described the case of a 4-year-old boy with non-craniosynostotic Chiari malformation and extensive cervical syrinx who, despite foramen magnum decompression and further revision, continued to deteriorate clinically and radiologically. Posterior calvarial augmentation was performed as a salvage procedure, with resolution of the tonsillar herniation and syrinx. CONCLUSIONS: Posterior calvarial augmentation is a viable option for patients with Chiari malformation refractory to foramen magnum decompression. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/32298820/Posterior_Calvarial_Augmentation_for_Chiari_Malformation_Type_1_Refractory_to_Foramen_Magnum_Decompression_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(20)30689-6 DB - PRIME DP - Unbound Medicine ER -