Small Posterior Fossa Strokes Causing Severe Vertigo - Clinical Signs and Anatomic Distribution of the "Lacunar" Acute Vestibular Syndrome (P02.249)

Objective Obstructive hydrocephalus in patients with posterior fossa tumors is frequently seen. Treatment options include immediate tumor removal or prior cerebrospinal fluid (CSF) diversion procedures. The necessity and feasibility of an ETV in these situations has not yet been proven in adult patients. Methods We retrospectively reviewed our prospectively maintained database for ETVs before surgery of posterior fossa tumors in adults. The primary focus of data analyses was the question of whether the ETV was suitable to treat the acute situation of hydrocephalus without an increased rate of complications due to the special anatomical situation with a posterior fossa tumor. We also analyzed whether any further CSF diverting procedures were necessary. Results A total of 40 adult patients who underwent an ETV before posterior fossa tumor surgery were analyzed. Overall, 33 patients (82.5%) had clinical signs of hydrocephalus, and all of them improved in their clinical course after ETV. Seven patients (17.5%) did not demonstrate clinical signs of hydrocephalus, but ETV was performed with prophylactic or palliative intent in six patients and one patient, respectively. No complications were observed due to ETV itself. No permanent shunting procedure was necessary in a mean follow-up of 76.5 months. Early additional CSF diverting procedures (redo ETV, external ventricular drain) were performed in five patients (12.5%). Conclusion The present series confirms the feasibility and safety of ETV before posterior fossa tumor surgery in adult patients. If patients had symptomatic hydrocephalus before tumor surgery, an ETV can be performed, followed by early elective tumor surgery. A prophylactic ETV in asymptomatic patients is not advised. Early elective tumor surgery should be performed in these patients.

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Foramen magnum decompression without bone removal: C1–C2 posterior fixation for Chiari with congenital atlantoaxial dislocation/basilar invagination

Surgical Neurology International ◽

10.25259/sni-38-2019 ◽

2019 ◽

Vol 10 ◽

pp. 38 ◽

Cited By ~ 5

Author(s):

Pravin Salunke ◽

Madhivanan Karthigeyan ◽

Puneet Malik

Keyword(s):

Posterior Fossa ◽

Craniovertebral Junction ◽

Basilar Invagination ◽

Foramen Magnum ◽

Atlantoaxial Dislocation ◽

Posterior Fixation ◽

Foramen Magnum Decompression ◽

Radiological Data ◽

C2 Fixation ◽

Small Posterior Fossa

Background: Atlantoaxial dislocation (AAD) and basilar invagination (BI) may coexist with Chiari malformations (CM) and a small posterior fossa volume. These are typically treated with craniovertebral junction fusion and foramen magnum decompression (FMD). Here, we evaluated whether C1–C2 posterior reduction and fixation (which possibly opens up the ventral foramen magnum) would effectively treat AAD and CM without additionally performing FMD. Methods: This is a retrospective analysis of 38 patients with BI, AAD, and CM who underwent C1–C2 posterior reduction and fusion without FMD. Baseline and follow-up clinical, demographic, and radiological data were evaluated. Results: The vast majority of patients (91.9%) improved both clinically and radiographically following C1–C2 fixation alone; none later required direct FMD. Notably, AAD was irreducible in 25 (65.8%) patients. Preoperatively, syringomyelia was present in 28 (73.7%) patients and showed resolution. In 3 (8.1%) patients, resolution of syrinxes did not translate into clinical improvement. Of interest, 5 patients who sustained inadvertent dural lacerations exhibited transient postoperative neurological worsening. Conclusions: Posterior C1–C2 distraction and fusion alone effectively treated AAD, BI, accompanied by CM. The procedure sufficiently distracted the dens, reversed dural tenting, and restored the posterior fossa volume while relieving ventral brainstem compression making FMD unnecessary. Surgeons should, however, be aware that inadvertent dural lacerations might contribute to unwanted neurological deterioration.

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Improvement of Hydrocephalus in Patients with Chiari Malformation After Posterior Fossa Decompression

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v27i1.801 ◽

2018 ◽

Vol 27 (1) ◽

pp. 71-73

Author(s):

Lindolfo Carlos Heringer ◽

Matheus Fernandes De Oliveira ◽

Ulysses Oliveira De Sousa ◽

Wanderley Cerqueira De Lima ◽

Ricardo Vieira Botelho

Keyword(s):

Posterior Fossa ◽

Chiari Malformation ◽

Clinical Symptoms ◽

Foramen Magnum ◽

Posterior Fossa Decompression ◽

Type I ◽

Chiari Malformation Type I ◽

Cisterna Magna ◽

Long Time ◽

Small Posterior Fossa

Introduction. The association between hydrocephalus and Chiari malformation (CM) has not been described frequently. Ventricular dilation affects 7% to 10% of patients with CM, but the ideal choice of surgical treatment is controversial. Wereport a case of a patient with Chiari malformation and hydrocephalus with improvement in clinical symptoms and ventricular dilatation. Case Description. A 19-year-old male complaining of frontal headache when coughing, laughing and during valsalva maneuvers, associated with dizziness for 2 months. Magnetic resonance (MR) showed hydrocephalus and small posterior fossa with overcrowding of contents, characterizing Chiari malformation type I, with cerebellar tonsils protruding through magnum foramen. Patient underwent surgery with posterior fossa decompression in a semi-sitting position and removal of the arc C1.After 3 months of follow-up, headache disappeared becoming asymptomatic. Control MR showed improvement of hydrocephalus with restoration of the cisterna magna and CSF flow. Discussion. Hydrocephalus has been related to CM for a long time. In our case, we performed treatment with intradural and intra-arachnoidal approach with bilateral tonsillectomy without placing ventricular shunt. The cisterna magna was “recreated”. There was improvement of hydrocephalus with decreased Evans ratio index and symptoms disappearance. Although there is no other studies addressing such matter, in this case, the improvement suggests that the CSF compression at the foramen magnum was the cause of associated hydrocephalus with Chiari malformation.

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Small Posterior Fossa as a Predisposition of Neurovascular Conflict

Skull Base ◽

10.1055/s-2005-916553 ◽

2005 ◽

Vol 15 (S 2) ◽

Author(s):

Vasek Masopust ◽

D. Netuka ◽

V. Benes

Keyword(s):

Posterior Fossa ◽

Neurovascular Conflict ◽

Small Posterior Fossa

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Vestibular vertigo in emergency neurology

Russian neurological Journal ◽

10.30629/2658-7947-2021-26-4-50-59 ◽

2021 ◽

Vol 26 (4) ◽

pp. 50-59

Author(s):

A. A. Kulesh ◽

D. A. Dyomin ◽

A. L. Guseva ◽

O. I. Vinogradov ◽

V. A. Parfyonov

Keyword(s):

Clinical Signs ◽

Neurological Status ◽

Diagnostic Methods ◽

Head Impulse Test ◽

Vestibular Disorders ◽

Vertebrobasilar System ◽

Acute Vestibular Syndrome ◽

Vestibular Vertigo ◽

Vestibular Neuronitis ◽

Emergency Neurology

The review deals with approaches to the differential diagnosis of the causes of vertigo in emergency neurology. The main causes of episodic and acute vestibular syndrome are discussed. Clinical diagnostic methods for acute vestibular syndrome (evaluation of nystagmus, test of skew, head-impulse test and neurological status) are considered. Clinical signs of “benign” acute vestibular syndrome and symptoms indicating a stroke in the vertebrobasilar system are presented. Differential diagnostic criteria for peripheral and central vestibular disorders are presented. Transient ischemic attacks, features of the otoneurologic status in vestibular neuronitis and different localizations of cerebral infarction focus are considered. Errors in the diagnosis of the vertigo causes are discussed.

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Surgical treatment of Chiari malformation with and without syringomyelia: experience with 177 adult patients

Journal of Neurosurgery ◽

10.3171/2012.10.jns12305 ◽

2013 ◽

Vol 118 (2) ◽

pp. 232-242 ◽

Cited By ~ 53

Author(s):

Ulrich Batzdorf ◽

David L. McArthur ◽

John R. Bentson

Keyword(s):

Clinical Outcome ◽

Posterior Fossa ◽

Chiari Malformation ◽

Clinical Signs ◽

Signs And Symptoms ◽

Surgical Decompression ◽

Imaging Studies ◽

Clinical Signs And Symptoms ◽

The Relationship ◽

Cerebellar Tonsils

Object This study aims to show the relationship between clinical outcome in patients who underwent surgical decompression for Chiari malformation (CM) and postoperative imaging studies, with particular emphasis on the subarachnoid cisterns of the posterior fossa. Methods One hundred seventy-seven patients with CM, including 97 with syringomyelia, underwent posterior fossa decompressive surgery. Both the dura and arachnoid were opened in 150 of these patients, and 135 underwent reduction of the cerebellar tonsils. The patients' clinical signs and symptoms were evaluated at 2 time points after surgery. Their imaging studies were analyzed specifically for the size of the retrotonsillar and subtonsillar cisterns and the syringomyelic cavities. The authors evaluated the relationship between these imaging findings and clinical parameters. Results Clinical improvement correlated strongly with enlargement of the subarachnoid cisterns, and enlargement of the cisterns also correlated with reduction in size of the syrinx cavities. Symptoms related to syringomyelia responded to reduction in size of the syrinx cavities. Conclusions Surgical decompression of the posterior fossa should aim to create relatively large subarachnoid cisterns and reduce the size of the syrinx cavity. Reduction of the cerebellar tonsils by surgical means, together with duraplasty, achieves this goal and thereby improves the clinical outcome for patients with CM. An incidental observation of the study is that obesity increases the likelihood of headache in patients with CM.

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A Modification of the Classic Technique for Expansion Duroplasty of the Posterior Fossa

Operative Neurosurgery ◽

10.1227/01.neu.0000249239.28107.88 ◽

2007 ◽

Vol 60 (suppl_2) ◽

pp. ONS-60-ONS-62 ◽

Cited By ~ 1

Author(s):

Fahrad Pirouzmand ◽

William S. Tucker

Keyword(s):

Posterior Fossa ◽

Foramen Magnum ◽

New Method ◽

Simple Modification ◽

Traditional Technique ◽

Transverse Expansion ◽

Classic Technique ◽

Dural Opening ◽

Small Posterior Fossa

Abstract Objective: Expansion of the posterior fossa is the goal in treatment of many neurosurgical diseases sharing a small posterior fossa and/or tightness at the level of foramen magnum. To further enhance the dural opening at the level of foramen magnum, a modification in the duroplasty technique is suggested. Methods: A simple modification of the classic Y-shaped technique for expansion duroplasty of the posterior fossa is described. This includes an “inverse V-shaped” extension at the bottom of linear durotomy. Results: The key advantage of this technique is creating more transverse expansion of the dural opening in the lower part of duroplasty. This technique has been used in six patients with no technical difficulties or complications. Conclusion: This new method of dural opening provides a safe and likely efficient addition to the traditional technique of posterior fossa durotomy.

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A morphometric CT study of Down's syndrome showing small posterior fossa and calcification of basal ganglia

Neuroradiology ◽

10.1007/bf00342687 ◽

1984 ◽

Vol 26 (6) ◽

pp. 493-498 ◽

Cited By ~ 33

Author(s):

Atsushi Ieshima ◽

Toshiro Kisa ◽

Kunio Yoshino ◽

Sachio Takashima ◽

Kenzo Takeshita

Keyword(s):

Basal Ganglia ◽

Posterior Fossa ◽

Down's Syndrome ◽

Down’S Syndrome ◽

Small Posterior Fossa

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Ultrasonographic Detection of Perinatal Intracerebellar Hemorrhage

PEDIATRICS ◽

10.1542/peds.70.3.385 ◽

1982 ◽

Vol 70 (3) ◽

pp. 385-386 ◽

Cited By ~ 2

Author(s):

John D. Reeder ◽

Emmalee S. Setzer ◽

Juri V. Kaude

Keyword(s):

Posterior Fossa ◽

Intracranial Hemorrhage ◽

Premature Infants ◽

Surgical Intervention ◽

Clinical Signs ◽

Life Threatening ◽

Prompt Diagnosis ◽

Life Threatening Event

Intracerebellar hemorrhage in premature infants represents a life-threatening event. Prompt diagnosis of this form of intracranial hemorrhage is crucial, as surgical intervention may dramatically improve the prognosis. Whereas clinical signs associated with posterior fossa pathology in infants remain nonspecific, ultrasound provides a rapid, noninvasive means of identifying this potentially treatable abnormality. A case is presented.

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