scholarly journals Intracranial hypertension after Chiari decompression resolving after removal of a levonorgestrel-releasing intrauterine device: case report

2019 ◽  
Vol 131 (4) ◽  
pp. 1000-1003 ◽  
Author(s):  
Georgios A. Maragkos ◽  
Rouzbeh Motiei-Langroudi ◽  
Aristotelis S. Filippidis ◽  
Efstathios Papavassiliou
Keyword(s):  
Intracranial Hypertension ◽  
Intrauterine Device ◽  
Fluid Collection ◽  
Type I ◽  
Increased Intracranial Pressure ◽  
Chiari Malformation Type I ◽  
Persistent Problem ◽  
Suboccipital Craniectomy ◽  
Treatment Refractory ◽  
Needle Decompression

Levonorgestrel-releasing intrauterine devices (LIUDs) are thought to release this progestin locally in the uterus to limit side effects. Authors here present a case of treatment-refractory hydrocephalus and pseudomeningocele (PMC), both of which fully resolved after LIUD removal.A 35-year-old woman with an implanted LIUD developed symptomatic PMC and hydrocephalus after suboccipital craniectomy for Chiari malformation type I. Over the next 8 months, she underwent ventriculoperitoneal shunt placement and two attempts at needle decompression of the fluid collection, which did not relieve her symptoms or the PMC, except for a few days at a time. Subsequently, she had her LIUD removed. Three weeks after removal of the LIUD, her symptoms as well as the fluid collection resolved completely without any further intervention. Thus, the increased intracranial pressure and associated persistence of the PMC may be partially attributed to the LIUD.This case indicates that a persistent problem (PMC and intracranial hypertension) that may be associated with the LIUD rapidly resolves after its removal. Implication of LIUDs as the cause of intracranial hypertension is still a matter of controversy. Further studies are needed to evaluate any potential causal relationship between LIUDs and intracranial hypertension, and physicians are advised to consider this scenario in their differential diagnosis.

Quadriparesis due to the delayed formation of a compressive epidural cerebrospinal fluid collection following suboccipital craniectomy with duraplasty for Chiari malformation Type I

2007 ◽  
Vol 7 (4) ◽  
pp. 450-453 ◽  
Author(s):  
Daniel M. Oberer ◽  
Oran S. Aaronson ◽  
Joseph S. Cheng
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Chiari Malformation ◽  
Fluid Collection ◽  
Spontaneous Intracranial Hypotension ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Suboccipital Craniectomy ◽  
Neurological Insult

✓ The authors describe a previously undocumented complication of suboccipital craniectomy combined with duraplasty for the treatment of Chiari malformation Type I and propose techniques to prevent its occurrence. Although there have been reports of epidural pseudomeningoceles in the setting of spontaneous intracranial hypotension and intracranial hygromas following suboccipital craniectomy with duraplasty, the authors believe this case to be the first instance of quadriparesis caused by the delayed formation of a compressive epidural cerebrospinal fluid collection after suboccipital craniectomy with duraplasty. This complication is significant and must be recognized given the potential severity of neurological insult and the number of these procedures performed yearly in both the pediatric and adult populations.

Intracranial hypertension in 2 cases of craniometaphyseal dysplasia: differing surgical options

2011 ◽  
Vol 31 (2) ◽  
pp. E6 ◽  
Author(s):  
Mónica Rivero-Garvía ◽  
F. Javier Márquez-Rivas ◽  
Antonia García-Iglesias ◽  
Raquel Gutiérrez-González
Keyword(s):  
Mr Imaging ◽  
Intracranial Hypertension ◽  
Chiari Malformation ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Decompressive Craniotomy ◽  
Csf Shunting ◽  
Surgical Options ◽  
Exon 9 ◽  
Craniometaphyseal Dysplasia

Craniometaphyseal dysplasia (CMD) is a very rare bone disorder characterized by abnormally developed metaphyses in long bones and sclerosis of the craniofacial bones. In this paper, the authors report 2 cases of children diagnosed with CMD and chronic intracranial hypertension with deletion in exon 9 of the human ANK gene (ANKH). After intracranial monitoring, a different treatment was chosen for each patient. One of the patients was treated using CSF shunting because ventriculomegaly in the absence of a Chiari malformation was also observed on cerebral MR imaging. The other patient underwent cranial expansion and decompressive craniotomy of the posterior fossa, because ventriculomegaly was excluded after cerebral MR imaging and cervical MR imaging showed a Chiari malformation Type I. The origin of intracranial hypertension in CMD is multifactorial. Previous intracranial pressure monitoring and a thorough understanding of neuroimaging studies are essential to achieve an accurate diagnosis and effective treatment.

Nonoperative management of enlarging syringomyelia in clinically stable patients after decompression of Chiari malformation type I

2021 ◽  
Vol 28 (1) ◽  
pp. 28-33
Author(s):  
Nicholas S. Szuflita ◽  
Tiffany N. Phan ◽  
Jason H. Boulter ◽  
Robert F. Keating ◽  
John S. Myseros
Keyword(s):  
Chiari Malformation ◽  
Nonoperative Management ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Suboccipital Craniectomy ◽  
Close Observation ◽  
Lost To Follow Up ◽  
Serial Mri

OBJECTIVE The authors aimed to describe the natural history and optimal management of persistent syringomyelia after suboccipital craniectomy for Chiari malformation type I (CM-I). METHODS A cohort of all patients who presented to a tertiary pediatric hospital with newly diagnosed CM-I between 2009 and 2017 was identified. Patients with persistent or worsened syringomyelia were identified on the basis of a retrospective review of medical records and imaging studies. The management of these patients and their clinical courses were then described. RESULTS A total of 153 children with CM-I and syringomyelia were evaluated between 2009 and 2017. Of these, 115 (68.8%) patients underwent surgical intervention: 40 patients underwent posterior fossa decompression (PFD) alone, 43 underwent PFD with duraplasty, and 32 underwent PFD with duraplasty and fourth ventricle stent placement. Eleven (7.19%) patients had increased syringomyelia on subsequent postoperative imaging. Three of these patients underwent revision surgery because of worsening scoliosis or pain, 2 of whom were lost to follow-up, and 4 were managed nonoperatively with close surveillance and serial MRI evaluations. The syringes decreased in size in 3 patients and resolved completely in 1 patient. CONCLUSIONS Persistent or worsened syringomyelia after CM-I decompression is uncommon. In the absence of symptoms, nonoperative management with close observation is safe for patients with persistent syrinx.

scholarly journals Interlayer Dural Split Technique for Chiari I Malformation Treatment in Adult -- Technical Note

2021 ◽  
Author(s):  
Ioan Alexandru Florian ◽  
Mihaela Maria Pop ◽  
Teodora Larisa Timis ◽  
Ioan Stefan Florian
Keyword(s):  
Chiari Malformation ◽  
Chiari I Malformation ◽  
Sensory Loss ◽  
Posterior Arch ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Control Series ◽  
Suboccipital Craniectomy ◽  
Chiari I ◽  
Split Technique

Objective: To present an alternative surgical technique in treating cases of Chiari I Malformation with mild-to-moderate syringomyelia after decompressive suboccipital craniectomy: incising only the outer layer of the dura mater, then dissecting it from the inner layer without opening the latter. Methods and Results: We utilized this technique in a short series of three cases who were admitted in our department for mild symptoms such as intermittent headache and dissociated sensory loss in the upper limbs, caused by a Chiari Malformation Type I. The patients were placed in the sitting position. We performed a reduced median suboccipital craniectomy and resection of the posterior arch of C1 adapted to the level of tonsil descent, from a limited superior half to a complete resection. Afterwards, we incised the outer dural layer, while sparing the inner one. Using a fine dissector, we then split apart the outer and inner layers to the margin of the craniectomy. Through the transparency of the inner layer and the arachnoid, the cerebellum and the medulla were visible and pulsating. An autologous fascia duraplasty was then performed. The postoperative course was favorable in all cases, patients being discharged without any deficits and with complete symptom resolution. Conclusions: Interlayer dural split technique can be used effectively in treating symptomatic cases of type I Chiari malformation in adults, with mild-to-moderate syringomyelia. It is less invasive than opening the dura and possibly more effective than decompressive craniectomy and C1 laminectomy alone. This technique must be validated in a larger case-control series.

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

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 33 ◽  
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.

scholarly journals Yawning in neurology: a review

2018 ◽  
Vol 76 (7) ◽  
pp. 473-480 ◽  
Author(s):  
Hélio A. G. Teive ◽  
Renato P. Munhoz ◽  
Carlos Henrique F. Camargo ◽  
Olivier Walusinski
Keyword(s):  
Multiple Sclerosis ◽  
Amyotrophic Lateral Sclerosis ◽  
Brain Tumor ◽  
Intracranial Hypertension ◽  
Clinical Condition ◽  
Chiari Malformation ◽  
Type I ◽  
Drug Induced ◽  
Chiari Malformation Type I ◽  
Lateral Sclerosis

ABSTRACT Yawning is a stereotyped physiological behavior that can represent a sign or symptom of several conditions, such as stroke, parakinesia brachialis oscitans, parkinsonism, Parkinson’s disease and epilepsy. More rarely, it can occur in patients with intracranial hypertension, brain tumor, multiple sclerosis, migraine, Chiari malformation type I, and amyotrophic lateral sclerosis. Drug-induced yawning is an uncommon clinical condition and yawning in patients with autism or schizophrenia is very rare. The aim of this review is to describe in detail the occurrence of the phenomenon in such conditions, and its’ phenomenology and pathophysiology.

scholarly journals Lumbar subdural cerebrospinal fluid collection with acute cauda equina syndrome after posterior fossa decompression for Chiari malformation Type I: case report

2016 ◽  
Vol 25 (3) ◽  
pp. 328-331 ◽  
Author(s):  
Houssein A. Darwish ◽  
Edward H. Oldfield
Keyword(s):  
Posterior Fossa ◽  
Cauda Equina Syndrome ◽  
Chiari Malformation ◽  
Fluid Collection ◽  
Cauda Equina ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Subdural Hygroma ◽  
Chiari Malformation Type I ◽  
Clinically Significant

This report describes the circumstances of a patient with a cauda equina syndrome due to the development of a lumbar subdural CSF collection with ventral displacement of the cauda equina shortly following posterior fossa decompression for Chiari malformation Type I (CM-I). This unusual, but clinically significant, complication was successfully treated with percutaneous drainage of the extraarachnoid CSF collection. Although there are a few cases of intracranial subdural hygroma developing after surgery for CM-I, often attributed to a pinhole opening in the arachnoid, as far as the authors can determine, a spinal subdural hygroma associated with surgery for CM-I has not been recognized.

scholarly journals Imaging Findings in Chiari I Malformation with Syringomyelia in a Case of Charcot Shoulder

2011 ◽  
Vol 1 ◽  
pp. 46 ◽  
Author(s):  
Shantanu Kumar ◽  
Vineet Sharma ◽  
Santosh Kumar ◽  
Sonal Jain
Keyword(s):  
Shoulder Joint ◽  
Fluid Collection ◽  
Joint Space ◽  
Chiari I Malformation ◽  
Type I ◽  
Neuropathic Arthropathy ◽  
Chiari Malformation Type I ◽  
Lateral Dislocation ◽  
Chiari I ◽  
The Right

Neuropathic arthropathy of the shoulder is reported in only 5% of cases. Here, we report a rare case of neuropathic arthropathy of the shoulder, secondary to Chiari malformation Type I with associated syringomyelia, that remained undetected for four years. A 38-year-old female presented to our Department with a swelling over the right shoulder that had persisted for four years. X-ray of the joint showed destruction of the head of the right humerus, with typical blunt amputated appearance of the bone and increased joint space. Magnetic resonance imaging showed destruction and lateral dislocation of the head of the humerus. Large amount of fluid collection was seen in and around the right shoulder joint. Neuropathic osteoarthropathy can be defined as bone and joint changes that occurs secondary to loss of sensation. In our case, neuropathic shoulder joint was secondary to syringomyelia associated with Chiari I malformation.

scholarly journals Hemifacial Spasm Associated with Chiari Type I Malformation: Surgical Considerations and Case Report

2020 ◽  
Vol 39 (02) ◽  
pp. 136-141
Author(s):  
Carlos Augusto Ferreira Lobão ◽  
Ulysses de Oliveira Sousa ◽  
Diego Arthur Castro Cabral ◽  
Fernanda Myllena Sousa Campos
Keyword(s):  
Facial Nerve ◽  
Posterior Fossa ◽  
Hemifacial Spasm ◽  
Foramen Magnum ◽  
Type I ◽  
Posterior Fossa Surgery ◽  
Chiari Malformation Type I ◽  
Chiari Type I Malformation ◽  
Suboccipital Craniectomy ◽  
Clinical Worsening

AbstractHemifacial spasm (HS) is a movement disorder characterized by paroxysmal and irregular contractions of the muscles innervated by the facial nerve. Chiari malformation type I (CM I) is a congenital disease characterized by caudal migration of the cerebellar tonsils, and surgical decompression of foramen magnum structures has been used for treatment. The association of HS with CM I is rare, and its pathophysiology and therapeutics are speculative. There are only a few cases reported in the literature concerning this association. The decompression of the posterior fossa for the treatment of CM I has been reported to relieve the symptoms of HS, suggesting a relation between these diseases. However, the possible complications of posterior fossa surgery cannot be underrated. We report the case of a 66-year-old patient, in ambulatory follow-up due to right HS, no longer responding to botulinum toxin treatment. Magnetic resonance imaging (MRI) of the skull revealed compression of the facial nerve and CM I. The patient underwent surgery for HS by neurovascular microdecompression of the facial nerve via right lateral suboccipital craniectomy, but presented significant clinical worsening in the postoperative period even though the cerebellum edema related to surgical manipulation was mild. Due to the clinical worsening, the patient underwent a median suboccipital craniectomy with decompression of the foramen magnum structures. After this second surgery, the patient had progressive improvement and was discharged from the hospital for ambulatory care.

Heterotopic ossification following suboccipital craniectomy decompression surgery for Chiari malformation type I: case report

2019 ◽  
Vol 23 (6) ◽  
pp. 704-707 ◽  
Author(s):  
Christopher E. Louie ◽  
Jennifer Hong ◽  
David F. Bauer
Keyword(s):  
Heterotopic Ossification ◽  
Chiari Malformation ◽  
Bone Growth ◽  
Low Cost ◽  
Rare Complication ◽  
Decompression Surgery ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Suboccipital Craniectomy

Suboccipital craniectomy with duraplasty is a commonly performed procedure for children with symptomatic Chiari malformation type I (CM-I). Several dural substitutes are used for duraplasty, ranging from pericranium to synthetic materials. When available, autologous pericranium is often preferred due to its low cost, performance in obtaining a watertight closure, ease of suturing, and absence of immune reaction. Long-term follow-up data on the durability of various dural substitutes are lacking. The authors report a rare, long-term complication of duraplasty performed using an autologous pericranial graft, and they conduct a literature review of similar complications. Heterotopic ossification of an autologous pericranial graft is a rare complication of duraplasty. This dystrophic bone growth can be symptomatic due to compression of neural structures, and it requires reoperation for removal. Surgeons should consider this rare long-term complication in patients presenting with unusual symptoms after duraplasty with pericranium.

Sign in / Sign up

Export Citation Format

Share Document