Chiari malformation with syringocephaly

1991 ◽  
Vol 75 (5) ◽  
pp. 791-794 ◽  
Author(s):  
Eric L. Rhoton ◽  
Albert L. Rhoton
Keyword(s):  
Chiari Malformation ◽  
Mass Effect ◽  
Chiari I Malformation ◽  
Cerebral Peduncle ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
Root Entry Zone ◽  
Dural Graft ◽  
Upper Cervical ◽  
The Right

✓ A 69-year-old white woman presented with a left hemiparesis which progressed to quadriparesis and encephalopathy. Computerized tomography and magnetic resonance imaging revealed a Chiari I malformation and a hydromyelic cavity extending from C-2 to T-6. Rostrally, the cavity extended through the ventral medulla, pons, and right cerebral peduncle into the right cerebral hemisphere, where the cavity enlarged and was associated with mass effect. The patient has made a dramatic neurological recovery following suboccipital craniectomy with insertion of a dural graft to decompress the Chiari malformation and upper cervical laminectomy and dorsal root entry zone myelotomy to decompress the hydromyelia.

Microsurgery of Arnold-Chiari malformation in adults with and without hydromyelia

1976 ◽  
Vol 45 (5) ◽  
pp. 473-483 ◽  
Author(s):  
Albert L. Rhoton
Keyword(s):  
Chiari Malformation ◽  
Foramen Magnum ◽  
Intramedullary Tumor ◽  
Entry Zone ◽  
Content Type ◽  
Arnold Chiari Malformation ◽  
Suboccipital Craniectomy ◽  
Root Entry Zone ◽  
Upper Cervical ◽  
Bulbar Dysfunction

✓ Microsurgical exploration of 15 adults with Arnold-Chiari malformation with and without hydromyelia using 3 to 20 × magnification has led to the following conclusions. Hydromyelia, associated with Arnold-Chiari malformation, is a progressive mechanical disorder that causes spinal cord deficits by pressure distention of the cord. Arnold-Chiari malformation causes slowly or suddenly progressive bulbar dysfunction by impaction of the malformation in the foramen magnum. Decompression of both can be achieved by a suboccipital craniectomy, upper cervical laminectomy, establishing an outlet from the fourth ventricle, and opening the distended cord in the thinnest exposed area, which is usually along the dorsal root entry zone. If Pantopaque myelography in patients in the supine position shows the Arnold-Chiari malformation, hydromyelia can be established as a cause of central cord deficit even if myelography shows the cord size to be normal. Syringomyelia, traditionally considered a degenerative disease, is a less common cause of a slowly progressive central cord deficit than either hydromyelia or intramedullary tumor.

Cerebral dissection from syringomyelia demonstrated using cine magnetic resonance imaging

2001 ◽  
Vol 94 (2) ◽  
pp. 318-321 ◽  
Author(s):  
June Ho Lee ◽  
Chun-Kee Chung ◽  
Hyun Jib Kim
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Chiari I Malformation ◽  
Magnetic Resonance Images ◽  
Resonance Imaging ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
Upper Cervical ◽  
Chiari I ◽  
Fine Print

✓ A 16-year-old boy presented at the authors' emergency department with a sudden deterioration of respiration. He had been paraparetic for 3 years and had become quadriplegic 2 days previously. Magnetic resonance images revealed a Chiari I malformation and a hydromyelic cavity extending from C-1 to T-11. Rostrally, a small cylindrically shaped lesion extended from the cervicomedullary junction to the left semioval center. The patient made a dramatic neurological recovery following suboccipital craniectomy and upper cervical laminectomies with augmentation duraplasties followed by placement of a syringoperitoneal shunt.

Treatment of occipital neuralgia by partial posterior rhizotomy at C1–3

1995 ◽  
Vol 82 (4) ◽  
pp. 581-586 ◽  
Author(s):  
David Dubuisson
Keyword(s):  
Sensory Loss ◽  
Minimal Risk ◽  
Occipital Neuralgia ◽  
Content Type ◽  
Occipital Nerve ◽  
Root Entry Zone ◽  
Relieve Pain ◽  
Greater Occipital Nerve ◽  
Upper Cervical ◽  
Postoperative Vertigo

✓ To minimize the sensory loss associated with intradural posterior rhizotomy for medically refractory occipital neuralgia, partial sectioning of the upper cervical posterior rootlets was performed in 11 patients. The ventrolateral aspect of each posterior rootlet from C-1 to the upper portion of C-3 was divided at the root entry zone. In three patients with bilateral neuralgia, the procedure was performed on both sides, for a total of 14 partial rhizotomy procedures in the 11 patients. This resulted in satisfactory preservation of scalp sensation in all cases. Pain within the territory of the greater occipital nerve was consistently reduced or abolished by this procedure. The overall degree of pain relief was rated good or excellent after 10 of the 14 procedures. The other four procedures alleviated pain in the territory of the greater occipital nerve, but the results were marred by persistent periorbital or temporal pain. Two patients subsequently underwent complete C1–3 posterior rhizotomy without further improvement. Although partial posterior rhizotomy at C1–3 did not always relieve pain in the periorbital and temporal regions, this procedure did provide consistent long-term relief of severe occipital pain with minimal risk of postoperative vertigo, scalp anesthesia, or deafferentation syndrome.

Endovascular trapping of giant serpentine aneurysms by using Guglielmi detachable coils. Successful reduction of mass effect

2001 ◽  
Vol 94 (5) ◽  
pp. 836-840 ◽  
Author(s):  
Goro Otsuka ◽  
Shigeru Miyachi ◽  
Takashi Handa ◽  
Makoto Negoro ◽  
Takeshi Okamoto ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Therapeutic Option ◽  
Complex Structure ◽  
Mass Effect ◽  
Collateral Flow ◽  
Guglielmi Detachable Coils ◽  
Content Type ◽  
Effective Therapeutic Option ◽  
Detachable Coils ◽  
The Right

✓ Giant serpentine aneurysms (GSAs) are defined as partially thrombosed giant aneurysms with persistent serpentine vascular channels. Surgical management of these rare lesions is difficult because of their large size, complex structure, and unique hemodynamics. The authors report two cases of patients harboring GSAs with mass effect, which were managed effectively with endovascular treatment. The first patient was a 48-year-old man who presented with left homonymous hemianopsia caused by a GSA involving the terminal portion of the right internal carotid artery. The second patient, a 10-year-old boy, presented with tetraparesis from compression of the cervicomedullary junction by a GSA of the right vertebral artery. In each case, after confirming collateral flow by temporarily occluding the proximal artery, the aneurysm was trapped by placement of Guglielmi detachable coils at the sites at which the serpentine channels entered and exited the aneurysm. The midportion of each channel was isolated completely without packing, to maximize resorption of the devascularized mass. Mass effect and clinical symptoms rapidly improved in both cases, with no associated morbidity. We recommend endovascular trapping as a safe and effective therapeutic option for GSAs.

Anterior atlas fracture following suboccipital decompression for Chiari I malformation

2004 ◽  
Vol 1 (1) ◽  
pp. 137-140 ◽  
Author(s):  
Brian A. O'Shaughnessy ◽  
Sean A. Salehi ◽  
Saad Ali ◽  
John C. Liu
Keyword(s):  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Posterior Arch ◽  
Cervical Pain ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
Increased Risk ◽  
Downward Displacement ◽  
Chiari I ◽  
Suboccipital Decompression

✓ Chiari I malformation, a congenital disorder involving downward displacement of the cerebellar tonsils through the foramen magnum, is often treated surgically by performing suboccipital craniectomy and C-1 laminectomy. The authors report two cases in which fracture of the anterior atlantal arch occurred during the postoperative period following Chiari I decompression and C-1 laminectomy causing significant neck pain. The findings indicate that interruption of the integrity of the posterior arch of C-1, iatrogenically or otherwise, confers increased risk of anterior arch fracture. A C-1 fracture should therefore be considered in the differential diagnosis of posterior cervical pain in patients who have previously undergone decompression for Chiari I malformation.

Oscillopsia and Primary Cerebellar Ectopia: Case Report and Review of the Literature

Neurosurgery ◽  
1991 ◽  
Vol 29 (6) ◽  
pp. 932-936 ◽  
Author(s):  
Scott I. Gingold ◽  
Jeffrey A. Winfield
Keyword(s):  
Early Recognition ◽  
Complete Recovery ◽  
Visual Disturbance ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Downbeat Nystagmus ◽  
Suboccipital Craniectomy ◽  
Stationary Objects ◽  
Upper Cervical ◽  
Chiari I

Abstract Oscillopsia, the visual sensation of stationary objects swaying back and forth or vibrating, has been described in association with downbeat nystagmus in patients with primary cerebellar ectopia (Chiari I malformation). A patient with symptomatic oscillopsia without downbeat nystagmus, who was diagnosed by magnetic resonance imaging to have displaced cerebellar tonsils below the foramen magnum, is presented here. Suboccipital craniectomy and upper cervical laminectomy completely relieved the visual disturbance of the patient. The pathogenesis and surgical management of oscillopsia are discussed with respect to the current literature. Early recognition and surgical decompression of cerebellar ectopia may lead to complete recovery in patients with minimal symptomatology.

scholarly journals Ventrolateral Partial Dorsal Root Entry Zone Rhizotomy for Occipital Neuralgia

2005 ◽  
Vol 10 (1) ◽  
pp. 43-45 ◽  
Author(s):  
Serge Rasskazoff ◽  
Anthony M Kaufmann
Keyword(s):  
Occipital Neuralgia ◽  
Nerve Blocks ◽  
Medical Treatments ◽  
Dorsal Roots ◽  
Root Entry Zone ◽  
Upper Cervical ◽  
History Of ◽  
Multiple Trials ◽  
Touch Sensation ◽  
The Right

OBJECTIVE AND IMPORTANCE: Medically refractory occipital neuralgia (ON) has been treated with a variety of neuroablative procedures. The present case report supports the effectiveness of ventrolateral partial rhizotomy (pVL-DREZ) of the C1 to C3 cervical dorsal roots, a relatively unknown procedure.CLINICAL PRESENTATION: A 46-year-old woman had a 14-month history of severe right-sided ON. Multiple trials of medical treatments, nerve blocks and local steroid injections had failed. Her daily opioid requirements had escalated to include frequent injections in addition to prescribed oral opiates.INTERVENTION AND RESULTS: A pVL-DREZ at the right C1 to C3 level was performed through a C1 laminectomy and C2 right laminotomy. The ipsilateral upper cervical dorsal roots were exposed and a 1 mm deep incision was made at a 45° angle to the sagittal midline at the ventrolateral aspect of each dorsal rootlet entry. The patient experienced postoperative opioid withdrawal seizure and transient disequilibrium for two weeks. Touch sensation was preserved and complete abolition of ON over a four year follow-up was achieved.CONCLUSION: The pVL-DREZ procedure provided complete pain relief for the patient and avoided the potential complications often encountered with other destructive interventions. pVL-DREZ should be considered among the available options for the treatment of refractory ON.

The microsurgical anatomy of the jugular foramen

1995 ◽  
Vol 83 (5) ◽  
pp. 903-909 ◽  
Author(s):  
S. Adetokunboh Ayeni ◽  
Kenji Ohata ◽  
Kiyoaki Tanaka ◽  
Akira Hakuba
Keyword(s):  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Microsurgical Anatomy ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
The Right ◽  
Posterior Meningeal Artery ◽  
Distal Sigmoid

✓ The microsurgical anatomy of the jugular foramen was studied in 10 fixed cadavers, each cadaver consisting of the whole head and neck. Five of the cadavers were injected with latex. The jugular foraminal region was exposed using the infratemporal fossa type A approach of Fisch and Pillsbury in five cadavers (10 sides) and the combined cervical dissection—mastoidectomy—suboccipital craniectomy approach in five cadavers (10 sides). The right foramen was larger than the left in seven cases (70%), equal in two cases (20%), and smaller in one case (10%). The dura covering the intracranial portal of the foramen had two perforations, a smaller anteromedial perforation through which passed the ninth cranial nerve (CN IX), and a larger posterolateral perforation, through which passed the 10th and 11th cranial nerves (CNs X and XI) and the distal sigmoid sinus. The perforations were separated by a fibrous septum in 16 specimens (80%). After exiting the posterior fossa, CNs IX, X, and XI all lay anteromedial to the superior jugular bulb (SJB) within the jugular foramen. The inferior petrosal sinus (IPS) entered the foramen between CNs IX and X in most cases; however, in 10% of our cases it entered the foramen between CNs X and XI, and in 10% it entered the foramen caudal to CN XI. The IPS terminated in the SJB in 90% of our cases; in 40%, the IPS termination consisted of multiple channels draining into both the SJB and internal jugular vein. This study shows that the arrangement of the neurovascular structures within the jugular foramen does not conform to the hitherto widely accepted notion of discrete compartmentalization into an anteromedial pars nervosa containing CN IX and the IPS and a posterolateral pars venosa containing the SJB, CNs X and XI, and the posterior meningeal artery.

Spontaneous resolution and recurrence of a Chiari I malformation and associated syringomyelia

2000 ◽  
Vol 92 (2) ◽  
pp. 207-210 ◽  
Author(s):  
John C. L. Sun ◽  
Paul Steinbok ◽  
D. Douglas Cochrane
Keyword(s):  
Chiari Malformation ◽  
Chiari I Malformation ◽  
Spontaneous Resolution ◽  
Content Type ◽  
Chiari I ◽  
Fine Print

✓ The spontaneous resolution of syringomyelia has been reported infrequently. In patients with Chiari I malformations, resolution of the syringomyelia has sometimes been associated with improvement of their malformation. The authors present a case of spontaneous resolution followed by recurrence of syringomyelia and a corresponding change in the Chiari malformation. This case is of interest in light of the theories postulated to explain spontaneous resolution of syringomyelia.

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.

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