Spinal subdural hematoma post foramen magnum decompression—rare complication in a patient with rhomboencephalosynapsis

Tonsillar herniation and coning is a rare complication of meningoencephalitis and is associated with poor neurological outcome. Our patient presented unresponsive with radiological evidence of tonsillar herniation secondary to meningoencephalitis. She underwent an emergency foramen magnum decompression and C1 laminectomy with full recovery.16 years old female presented to her local ED with headache, vomiting, hallucinations, photophobia and neck stiffness. Her CT head was normal. She was commenced on acyclovir and ceftriaxone on the same day and clinically improved. LP performed 24 hours later showed WBC of 226 (200 lymphocytes, 6 polymorphs), protein 1.2 g/L, negative MC and S, negative viral PCR, negative TB PCR. CSF glucose was not sent. In light of a predominantly lymphocytic CSF and presumed viral meningitis antibiotics were stopped. Three days later acutely deteriorated. MRI head showed evidence of tonsillar herniation. She was restarted on antibiotics and was transferred to tertiary centre. She underwent emergency insertion of an EVD, foramen magnum decompression and C1 arch laminectomy. She made a full recovery with no residual neurological deficit.The mainstay treatment of meningoenecephalitis is intravenous antibiotics. However, in cases complicated by tonsillar herniation with reactive pupils, foramen magnum decompression should be considered.

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Case Report: Acute obstructive hydrocephalus associated with infratentorial extra-axial fluid collection following foramen magnum decompression and durotomy for Chiari malformation type I

F1000Research ◽

10.12688/f1000research.7627.1 ◽

2016 ◽

Vol 5 ◽

pp. 33 ◽

Cited By ~ 3

Author(s):

Sunil Munakomi ◽

Binod Bhattarai ◽

Pramod Chaudhary

Keyword(s):

Chiari Malformation ◽

Fourth Ventricle ◽

Rare Complication ◽

Obstructive Hydrocephalus ◽

Fluid Collection ◽

Foramen Magnum ◽

Type I ◽

Foramen Magnum Decompression ◽

Chiari Malformation Type I ◽

Definitive Role

Acute obstructive hydrocephalus due to infratentorial extra-axial fluid collection (EAFC) is an extremely rare complication of foramen magnum decompression (FMD) and durotomy for Chiari malformation type I. Presence of infratentorial EAFC invariably causes obstruction at the level of the fourth ventricle or aqueduct of Silvius, thereby indicating its definitive role in hydrocephalus. Pathogenesis of EAFC is said to be a local arachnoid tear as a result of durotomy, as this complication is not described in FMD without durotomy. Controversy exists in management. Usually EAFC is said to resolve with conservative management; so hydrocephalus doesn’t require treatment. However, in this case EAFC was progressive and ventriculo-peritoneal shunting (VPS) was needed for managing progressive and symptomatic hydrocephalus.

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Spinal subdural hematoma after lumbar discectomy without dural injury – Is it possible? A case report and literature review

Surgical Neurology International ◽

10.25259/sni-32-2019 ◽

2019 ◽

Vol 10 ◽

pp. 66

Author(s):

Juliano Nery Navarro ◽

Francisco de Assis Ulisses Sampaio ◽

Mario Sergio Duarte Andrioli ◽

Francisco Ricardo Ribeiro ◽

Mariano Ebram Fiore ◽

...

Keyword(s):

Case Report ◽

Magnetic Resonance ◽

Literature Review ◽

Subdural Hematoma ◽

Rare Complication ◽

Lumbar Discectomy ◽

Diagnostic Study ◽

Case Description ◽

Lumbar Microdiscectomy ◽

Spinal Subdural Hematoma

Background: Spinal subdural hematoma (SSDH) is a rare complication of lumbar discectomy. Here, the authors reviewed 10 articles concerning the etiology, clinical, diagnostic, and surgical management of SSDH. Case Description: A postoperative SSDH occurred following a lumbar microdiscectomy in an 80-year-old patient in the absence of a dural injury. Conclusion: SSDH is a rare complication of lumbar discectomy and may even occur without a dural fistula. Notably, magnetic resonance is the diagnostic study of choice to identify this pathology that may then be appropriately managed.

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Subdural Fluid Collection and Hydrocephalus After Foramen Magnum Decompression for Chiari Malformation Type I: Management Algorithm of a Rare Complication

World Neurosurgery ◽

10.1016/j.wneu.2017.07.112 ◽

2017 ◽

Vol 106 ◽

pp. 1057.e9-1057.e15 ◽

Cited By ~ 3

Author(s):

Zefferino Rossini ◽

Davide Milani ◽

Francesco Costa ◽

Carlotta Castellani ◽

Giovanni Lasio ◽

...

Keyword(s):

Chiari Malformation ◽

Rare Complication ◽

Fluid Collection ◽

Foramen Magnum ◽

Type I ◽

Subdural Fluid Collection ◽

Foramen Magnum Decompression ◽

Chiari Malformation Type I ◽

Management Algorithm

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Symptomatic posterior fossa and supratentorial subdural hygromas as a rare complication following foramen magnum decompression for Chiari malformation Type I

Journal of Neurosurgery ◽

10.3171/2010.8.jns10413 ◽

2011 ◽

Vol 114 (2) ◽

pp. 510-513 ◽

Cited By ~ 14

Author(s):

Biji Bahuleyan ◽

Girish Menon ◽

Easwer Hariharan ◽

Mridul Sharma ◽

Suresh Nair

Keyword(s):

Posterior Fossa ◽

Chiari Malformation ◽

Surgical Intervention ◽

Rare Complication ◽

Foramen Magnum ◽

Type I ◽

Foramen Magnum Decompression ◽

Subdural Hygroma ◽

Chiari Malformation Type I ◽

Good Outcome

Symptomatic subdural hygroma due to foramen magnum decompression for Chiari malformation Type I is extremely rare. The authors present their experience with 2 patients harboring such lesions and discuss treatment issues. They conclude that the possibility of subdural hygromas should be considered in all patients presenting with increased intracranial tension following foramen magnum decompression for Chiari malformation Type I. Immediate neuroimaging and appropriate surgical intervention provides a good outcome.

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Delayed pseudomyelomeningocele: a rare complication after foramen magnum decompression for Chiari malformation

Surgical Neurology ◽

10.1016/j.surneu.2007.08.031 ◽

2009 ◽

Vol 71 (3) ◽

pp. 357-361 ◽

Cited By ~ 9

Author(s):

Deniz Belen ◽

Uygur Er ◽

Levent Gurses ◽

Kazim Yigitkanli

Keyword(s):

Chiari Malformation ◽

Rare Complication ◽

Foramen Magnum ◽

Foramen Magnum Decompression

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Prognostic significance of C1–C2 facet malalignment after surgical decompression in adult Chiari malformation type I: a pilot study based on the Chicago Chiari Outcome Scale

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20544 ◽

2020 ◽

pp. 1-7

Author(s):

Michael Lumintang Loe ◽

Tito Vivas-Buitrago ◽

Ricardo A. Domingo ◽

Johan Heemskerk ◽

Shashwat Tripathi ◽

...

Keyword(s):

Pilot Study ◽

Chiari Malformation ◽

Prognostic Significance ◽

Foramen Magnum ◽

Bivariate Analysis ◽

Type I ◽

Foramen Magnum Decompression ◽

Swallowing Function ◽

Chiari Malformation Type I

OBJECTIVEThe authors assessed the prognostic significance of various clinical and radiographic characteristics, including C1–C2 facet malalignment, in terms of surgical outcomes after foramen magnum decompression of adult Chiari malformation type I.METHODSThe electronic medical records of 273 symptomatic patients with Chiari malformation type I who were treated with foramen magnum decompression, C1 laminectomy, and duraplasty at Mayo Clinic were retrospectively reviewed. Preoperative and postoperative Neurological Scoring System scores were compared using the Friedman test. Bivariate analysis was conducted to identify the preoperative variables that correlated with the patient Chicago Chiari Outcome Scale (CCOS) scores. Multiple linear regression analysis was subsequently performed using the variables with p < 0.05 on the bivariate analysis to check for independent associations with the outcome measures. Statistical software SPSS version 25.0 was used for the data analysis. Significance was defined as p < 0.05 for all analyses.RESULTSFifty-two adult patients with preoperative clinical and radiological data and a minimum follow-up of 12 months were included. Motor deficits, syrinx, and C1–C2 facet malalignment were found to have significant negative associations with the CCOS score at the 1- to 3-month follow-up (p < 0.05), while at the 9- to 12-month follow-up only swallowing function and C1–C2 facet malalignment were significantly associated with the CCOS score (p < 0.05). Multivariate analysis showed that syrinx presence and C1–C2 facet malalignment were independently associated with the CCOS score at the 1- to 3-month follow-up. Swallowing function and C1–C2 facet malalignment were found to be independently associated with the CCOS score at the 9- to 12-month follow-up.CONCLUSIONSThe observed results in this pilot study suggest a significant negative correlation between C1–C2 facet malalignment and clinical outcomes evaluated by the CCOS score at 1–3 months and 9–12 months postoperatively. Prospective studies are needed to further validate the prognostic value of C1–C2 facet malalignment and the potential role of atlantoaxial fixation as part of the treatment.

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Spinal subdural hematoma, neurilemmoma, and acute transverse myelopathy

Surgical Neurology ◽

10.1016/0090-3019(85)90208-3 ◽

1985 ◽

Vol 23 (4) ◽

pp. 367-370 ◽

Cited By ~ 20

Author(s):

Richard Aurelius Smith

Keyword(s):

Subdural Hematoma ◽

Transverse Myelopathy ◽

Spinal Subdural Hematoma

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Hydrosyringomyelia Associated with a Chiari I Malformation in Children and Adolescents

Neurosurgery ◽

10.1227/00006123-199004000-00006 ◽

1990 ◽

Vol 26 (4) ◽

pp. 591-597 ◽

Cited By ~ 61

Author(s):

Toyohiko Isu ◽

Yoshinohu Iwasaki ◽

Minoru Akino ◽

Hiroshi Abe

Keyword(s):

Surgical Treatment ◽

Children And Adolescents ◽

Foramen Magnum ◽

Chiari I Malformation ◽

Motor Deficits ◽

Foramen Magnum Decompression ◽

Axial Section ◽

Lower Cranial Nerve ◽

Thoracic Level ◽

Initial Symptoms

Abstract The clinical presentation, radiological features, and results of surgical treatment were analyzed in 17 cases of hydrosyringomyelia associated with a Chiari malformation, in children and adolescents younger than 20 years of age. The initial symptoms were a skeletal abnormality (71%), such as scoliosis (11 patients) or pes cavus (1 patient), pain or numbness (24%), and motor weakness (6%). Frequently seen signs on admission were sensory deficit (100%), scoliosis (85%), muscle weakness (64%), muscle atrophy (35%), and lower cranial nerve palsy (35%), The characteristic neurological findings were unilateral sensory and motor deficits (65%) with decreased or absent deep tendon reflexes on the same side. The localization of the syrinx on the axial section varied according to the level, even in the same patient. In 11 patients with unilateral sensory disturbances or unilateral sensory and motor deficits, the syrinx was located in the region corresponding to the posterolateral portion on the same side as that of sensory disturbance at the cervical or thoracic level. On the other hand, in 6 patients with bilateral sensory and motor deficits, the syrinx was located in the central portion and extended into the posterolateral portion of the more affected side. A syringosubarachnoid shunt was placed in 16 patients, foramen magnum decompression without closure of the obex was performed in 1 patient, ventriculoperitoneal shunt in 1 patient, terminal syringostomy in 1 patient, and foramen magnum decompression with terminal syringostomy in 1 patient. In 15 of 17 patients (88%), the neurological symptoms improved after an average follow-up of 4 years and 1 month. We think that as a surgical treatment, placement of a syringosubarachnoid shunt is effective.

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