Superficial siderosis associated with an iatrogenic posterior fossa dural leak identified on CT cisternography

2021 ◽  
pp. 197140092110428
Author(s):  
Ajay A Madhavan ◽  
Christopher P Wood ◽  
Allen J Aksamit ◽  
Kara M Schwartz ◽  
John L Atkinson ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Chiari I Malformation ◽  
Superficial Siderosis ◽  
Low Grade ◽  
Dural Defect ◽  
Ct Cisternography ◽  
Hemosiderin Deposition ◽  
Dural Leak ◽  
Chiari I ◽  
Dural Tears

Superficial siderosis refers to hemosiderin deposition along the pial surface of the brain and spinal cord. It results from chronic and repetitive low-grade bleeding into the subarachnoid space. Dural tears are a common cause of superficial siderosis. Although such tears typically occur in the spine, dural tears can also occur in the posterior fossa. In many cases, posterior fossa dural tears are iatrogenic, and patients may present with neuroimaging evidence of postoperative pseudomeningoceles. We present a case of superficial siderosis caused by a persistent posterior fossa dural leak. The patient presented with superficial siderosis 30 years after a Chiari I malformation repair. A pinhole-sized dural tear was identified preoperatively using computed tomography cisternography. The dural defect was successfully repaired. An additional small tear that was not seen on imaging was also identified at surgery and successfully repaired.

Chiari Type I Malformation Presenting as Hemifacial Spasm: Case Report

Neurosurgery ◽  
2005 ◽  
Vol 57 (2) ◽  
pp. E371-E371 ◽  
Author(s):  
Mustafa Efkan Colpan ◽  
Zeki Sekerci
Keyword(s):  
Facial Nerve ◽  
Posterior Fossa ◽  
Hemifacial Spasm ◽  
Chiari I Malformation ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Chiari Type I Malformation ◽  
Downward Displacement ◽  
Facial Spasm ◽  
Chiari I

ABSTRACT OBJECTIVE AND IMPORTANCE: We report on a patient with a Chiari I malformation presenting with right hemifacial spasm. Clinicians should consider the downward displacement of the hindbrain as a rare cause of hemifacial spasm in Chiari I malformation. CLINICAL PRESENTATION: An 18-year-old man was admitted with right hemifacial spasm. The results of the neurological examination were normal except for the facial spasm. Magnetic resonance imaging demonstrated a Chiari I malformation without syringomyelia. After surgery, the hemifacial spasm completely resolved. INTERVENTION: Posterior fossa decompression, C1 laminectomy, and duraplasty were performed. CONCLUSION: The hemifacial spasm could be attributed to compression and/or traction of the facial nerve because of downward displacement of the hindbrain in Chiari I malformation. Compression and/or traction might create irritation of the facial nerve that causes hemifacial spasm. Resolution of the hemifacial spasm after posterior fossa decompression could explain the facial nerve irritation in Chiari I malformation. Clinicians should consider Chiari malformation as a cause of hemifacial spasm and posterior fossa decompression as a potential treatment.

A Diskogenic Dural Defect is the Reason for the Ventral Location of the Epidural Spinal Fluid Collection Seen in Superficial Siderosis

2021 ◽  
pp. 10.1212/CPJ.0000000000001085
Author(s):  
Neeraj Kumar
Keyword(s):  
Fluid Collection ◽  
Initial Point ◽  
Spinal Fluid ◽  
Superficial Siderosis ◽  
Low Grade ◽  
Dural Defect ◽  
Dynamic Ct ◽  
Contrast Extravasation ◽  
Recent Developments ◽  
Dural Defects

AbstractPurpose of reviewSuperficial siderosis (SS) of the nervous system is often due to a dural pathology. This review focuses on recent developments related to the management of this subgroup of SS patients.Recent findingsThe presence of an epidural ventral spinal fluid collection in patients with SS is a clue to the presence of a diskogenic dural defect. The location of the defect is ascertained by a dynamic CT-myelogram which involves placing the patient in a prone position with hips elevated. This permits gravity assisted preferential ventral localization of the contrast and active scanning during contrast injection facilitates a precise delineation of the initial point of contrast extravasation which localizes the defect.SummaryDiskogenic dural defects are commonly the underlying etiology for SS in patients with a ventral spinal fluid collection. A dynamic CT-myelogram facilitates detection and subsequent repair of these defects which arrests the continued low-grade subarachnoid bleeding.

The “Three on a Stick” Incision—A Curvilinear Solution for the Occipital and Suboccipital Region

2021 ◽  
Author(s):  
Amir Kershenovich
Keyword(s):  
Posterior Fossa ◽  
Vascular Complications ◽  
Chiari I Malformation ◽  
Arachnoid Cysts ◽  
Chiari I ◽  
Cosmetic Outcomes ◽  
Hair Coverage ◽  
Suboccipital Approach ◽  
Chiari Malformations ◽  
Multiple Conditions

Abstract BACKGROUND Different conditions of the posterior fossa such as Chiari malformations, tumors, and arachnoid cysts require surgery through a suboccipital approach, for which a typical midline vertical linear incision is used. Curvilinear incisions have been carried in all other scalp regions other than the sub region for better cosmetic outcomes; a vertical curvilinear incision in the occipital and suboccipital region has not been reported. OBJECTIVE To evaluate the cosmetic value and safety of the “3 on a stick” vertical suboccipital curvilinear incision. METHODS We compared curvilinear to linear incisions, considering the scar's width, color, how conspicuous, and how well the scar could be covered by hair naturally. RESULTS Between 2010 and 2016, 68 children with Chiari I malformation were surgically intervened. The curvilinear incision was performed in 56 (82.4%) while a linear incision in 12 (17.6%) children. There were only 2 (2.9%) wound related complications (superficial dehiscences) in the curvilinear group and 1 additional dehiscence in a linear incision case. There were no neural or vascular complications. Scars were very similar among the 2 groups; both were equally conspicuous but curvilinear ones seemed to get covered better by hair. CONCLUSION The “3 on a stick” curvilinear incision of the suboccipital region is safe and allows for better hair coverage of the scar. It can be used for multiple conditions requiring a midline suboccipital or even occipital approach, such as Chiari malformations, tumors, and cysts.

scholarly journals T11/T12 ossification of the yellow ligament contributing to thoracic myelopathy in patient with posterior fossa arachnoid cyst and acquired incidental Chiari I malformation/syrinx

2021 ◽  
Vol 12 ◽  
pp. 246
Author(s):  
Toshiya Aono ◽  
Hideaki Ono ◽  
Takeo Tanishima ◽  
Akira Tamura ◽  
Isamu Saito
Keyword(s):  
Lower Extremity ◽  
Posterior Fossa ◽  
Arachnoid Cyst ◽  
Cord Compression ◽  
Chiari I Malformation ◽  
Case Description ◽  
Thoracic Myelopathy ◽  
Chiari I ◽  
New Onset

Background: Thoracic ossification of the yellow ligament (OYL) may contribute to myelopathy. In the case presented, the patient additionally had a chronic posterior fossa arachnoid cyst with an acquired Chiari I malformation and cervicothoracic syrinx. Case Description: A 40-year-old female with a posterior fossa arachnoid cyst found 17 years ago, and newly acquired Chiari I malformation (tonsils down 5 mm) with a C7-T5 syrnix, presented with the new onset of lower extremity myelopathy. The MR documented marked dorsolateral cord compression due to T11/T12 OYL. Six months following a laminectomy for resection of OYL, the patient was asymptomatic. Conclusion: In patients presenting with the new onset of lower extremity myelopathy, evaluation of the complete neuraxis may be warranted. Here, the patient has an unchanged posterior fossa arachnoid cyst with an acquired Chiari I malformation/C7-T5 syrinx. However, the patient’s symptoms were fully attributed to the MR-documented T11/T12 OYL that was successfully resected.

Posterior fossa morphometry in symptomatic pediatric and adult Chiari I malformation

2009 ◽  
Vol 16 (11) ◽  
pp. 1449-1454 ◽  
Author(s):  
Sunil V. Furtado ◽  
Kalyan Reddy ◽  
A.S. Hegde
Keyword(s):  
Posterior Fossa ◽  
Chiari I Malformation ◽  
Chiari I

scholarly journals Is Chiari I Malformation Associated With Fibromyalgia?

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. 443-449 ◽  
Author(s):  
Nathaniel F. Watson ◽  
Dedra Buchwald ◽  
Jack Goldberg ◽  
Kenneth R. Maravilla ◽  
Carolyn Noonan ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Sleep Disturbances ◽  
Cervical Spinal Cord ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Upper Cervical Spine ◽  
Fisher Exact Test ◽  
Contrast Imaging ◽  
Control Subjects ◽  
Chiari I

Abstract BACKGROUND: The symptoms of Chiari I Malformation (CIM) and fibromyalgia (FM) overlap. Some FM patients have been surgically treated for presumed CIM-type pathology. OBJECTIVE: To determine whether CIM is more common among FM patients than pain- and fatigue-free controls. METHODS: One hundred seventy-six participants with FM and 67 pain- and fatigue-free control subjects underwent magnetic resonance imaging of the brain and upper cervical spine. Posterior fossa cerebrospinal fluid flow was assessed with cardiac gated cine phase-contrast imaging at the craniocervical region. CIM was defined as inferior extension of cerebellar tonsils ≥ 5 mm below the basion-opisthion line of the foramen magnum or tonsillar position 3 to 5 mm below the basion-opisthion line plus abnormalities of CSF flow, posterior fossa volume, or hindbrain or cervical spinal cord movement. Visual analog scales, questionnaires, and interviews were used to collect data on sleep quality, fatigue, pain, and headache. We used regression techniques to examine the association of outcome measures with disease status and the Fisher exact test to compare the CIM prevalence in the 2 groups. RESULTS: The FM group was older (mean age, 50 vs 40 years) and more likely to be white (89% vs 73%) and female (93% vs 54%; P < .01). Mean tonsillar position and the prevalence of CIM (2.8% vs 4.5%; P = .69) were similar in the FM and control groups. FM patients experienced more headaches, pain, fatigue, and sleep disturbances than control subjects (P < .01). CONCLUSION: Most patients with FM do not have CIM pathology. Future studies should focus on dynamic neuroimaging of craniocervical neuroanatomy in patients with FM.

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