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Iampreechakul P, Wangtanaphat K, Hangsapruek S, Wattanasen Y, Lertbutsayanukul P, Siriwimonmas S. Acquired Chiari malformation Type I and holocord syringomyelia associated with a high-flow supratentorial fistulous arteriovenous malformations: A case report and literature review. Surg Neurol Int 2022; 13:217. [PMID: 35673663 PMCID: PMC9168309 DOI: 10.25259/sni_11_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/30/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Chiari malformation Type I (CMI) is generally considered a congenital lesion and typically associated with syringomyelia. Acquired CMI or adult Chiari malformation caused by intracranial mass is extremely rare. Brain arteriovenous malformations (AVMs) are characteristically symptomatic due to seizure, intracranial hemorrhage, or neurological deficit. We report an extremely rare case of an acquired CMI and extensive syringomyelia associated with a large supratentorial AVM. Case Description: A 35-year-old woman was referred to our institute after a diagnosis of CMI and extensive syringomyelia from whole-spine magnetic resonance imaging (MRI) due to complaining of low back pain radiating to the right leg for the past 1 month. She had intermittent headache for 2 years. The patient underwent suboccipital decompression and C1 laminectomy followed by duraplasty. Two months later, she developed severe right-sided sciatic pain and complete right foot drop. Follow-up MRI revealed progressive enlargement of a syrinx cavity at the lower spinal cord and a large right parieto-occipital AVM with markedly dilated cortical draining veins and diffuse engorgement of dural venous sinuses was detected. This AVM supplied mainly by enlarged cortical branches of the right middle cerebral artery and posterior cerebral artery with multiple dural supplies. Endovascular treatment of a high-flow fistulous AVM was successfully performed with N-butyl cyanoacrylate (NBCA) through the hypertrophic branches of the right middle cerebral artery. Four months after embolization, the patient had recovered completely from the right foot drop. Further staged embolization was planned to reduce the size and flow of the AVM before stereotactic radiosurgery. However, the patient was lost to follow-up due to financial reason. One year later, she developed sudden severe headache followed by alteration of conscious due to intraventricular hemorrhage from the AVM, leading to obstructive hydrocephalus requiring cerebrospinal fluid diversion. During a period of 2 years, the patient underwent several staged embolization with NBCA and Onyx. Final cerebral angiography after embolization demonstrated a significant reduction in size and flow of the brain AVM. A control whole-spine MRI revealed a significant reduction in syrinx size. At the end of embolization, the patient had no neurological deficit. However, she had suffered from persistent central neuropathic pain at the right lower extremity. The AVM remnant was further treated by stereotactic radiosurgery. Conclusion: Increased cerebral venous hypertension secondary to a high-flow supratentorial AVM leading to posterior fossa venous hypertension may play a major role in the pathogenesis of CMI, induced the formation of syringomyelia. Endovascular treatment of brain AVM, the underlying cause of CMI, resulted in a significant reduction of the size of the syrinx. The need for cranial imaging in initial evaluation of cases with adult Chiari malformation is important.
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Affiliation(s)
| | | | - Sunisa Hangsapruek
- Department of Neuroradiology, Prasat Neurological Institute, Bangkok, Thailand
| | - Yodkhwan Wattanasen
- Department of Neuroradiology, Prasat Neurological Institute, Bangkok, Thailand
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Muthiah N, McDowell MM, Zenonos G, Agarwal N, Snyderman CH, Friedlander RM, Gardner PA. Endoscopic Endonasal Resection of Cranio-Cervical Junction Chordoma and Ventral Chiari Decompression: A Case Report. Oper Neurosurg (Hagerstown) 2021; 21:E421-E426. [PMID: 34392369 DOI: 10.1093/ons/opab285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chiari I malformations secondary to other causes represent a small subset of presenting symptomatic cases. Typically, the primary cause of the malformation is addressed first and results in resolution of the malformation and symptoms. However, in some cases, a patient may present with both a primary Chiari I malformation and another unrelated neurosurgical lesions. OBJECTIVE To present a unique case in which resection of a ventral tumor allowed for spontaneous resolution of a simultaneously noted dorsal Chiari I malformation. METHODS Pertinent data, including presenting symptoms, hospital course, surgical notes, preoperative images, and postoperative images, were collected using the electronic medical record. RESULTS We present a case of a 46-yr-old man with a Chiari I malformation in conjunction with a ventral cranio-cervical junction chordoma. Endoscopic endonasal resection of the chordoma and ventral foramen magnum decompression resulted in radiographic resolution of the Chiari malformation and resolution of his symptoms. Our report represents a rare case of ventral foramen magnum decompression as a treatment for Chiari I malformation. CONCLUSION It is felt that the chordoma mass effect was not the source of the Chiari I malformation. Thus, both ventral and dorsal decompressions of the posterior fossa may be considered for Chiari I decompression in select circumstances.
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Affiliation(s)
- Nallammai Muthiah
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael M McDowell
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Georgios Zenonos
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert M Friedlander
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Di Perna G, Piatelli G, Rossi A, Consales A, Fiaschi P, Castaldo M, Pavanello M. Coexisting Retrocerebellar Arachnoid Cyst and Chiari Type 1 Malformation: 3 Pediatric Cases of Surgical Management Tailored to the Pathogenic Mechanism and Systematic Review of the Literature. World Neurosurg 2020; 148:44-53. [PMID: 33385608 DOI: 10.1016/j.wneu.2020.12.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Arachnoid cysts are benign cerebrospinal fluid collection within a duplication of arachnoid membrane and, when found in the retrocerebellar site, they may be associated with tonsils herniation. This rare situation of coexisting retrocerebellar arachnoid cyst (AC) and Chiari malformation type 1 (CM-1) have been previously reported in few cases (10 patients) with syringomyelia and hydrocephalus described to be the most relevant issues. The aim of this paper is to describe 3 pediatric cases of this condition with a systematic review of the literature, underlining the importance of surgical management tailored to the pathogenic mechanism. METHODS A restrospective analysis of patients treated for coexisting CM-1 and ACs at the authors' institution has been carried out. RESULTS A case of a 10-month-old baby with coexisting AC and CM-1 with tri-ventricular hydrocephalus treated with endoscopic third ventriculostomy, a case of a 1-year-old child with a huge retrocerebellar AC and CM-1 treated with a cysto-peritoneal shunt, and a case of a 15-year-old child with retrocerebellar AC causing symptomatic CM-1 treated with C0-C2 decompression, AC fenestration and duraplasty are described. A long-term follow-up is reported. CONCLUSIONS Surgical management of coexisting ACs and CM-1 should not aim at the complete resolution of the cyst or of tonsil herniation, especially when pediatric patients are treated. Rather, the purpose of the neurosurgeon should be to understand the underlying pathogenic mechanism, and then restoring both the cerebrospinal fluid flow in the posterior fossa and the dynamic equilibrium between ventricles, cyst, and subarachnoid space.
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Affiliation(s)
- Giuseppe Di Perna
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy; Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genova, Italy.
| | - Gianluca Piatelli
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | | | - Pietro Fiaschi
- Department of Neurosurgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Universitá; di Genova, Genova, Italy
| | - Margherita Castaldo
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Marco Pavanello
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Onyia CU, Akinniranye O, Olaitan A, Agoha C. Short Report on a Rare Presentation of Temporal Arachnoid Cyst and Lessons Learned. World Neurosurg 2019; 126:310-313. [PMID: 30885870 DOI: 10.1016/j.wneu.2019.02.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Stiff neck or nuchal rigidity is a significant clinical sign of neurologic disease. It is commonly associated with meningitis, subarachnoid hemorrhage, and posterior fossa tumors. It may also occur as a result of tonsillar impaction following pressure in the infratentorial compartment from an expanding posterior fossa mass. It is, however, not commonly known to be associated with uncal herniation. CASE DESCRIPTION We report a recent experience on this association. CONCLUSIONS In the presence of stiff neck or nuchal rigidity in a patient with clinical signs of uncal herniation from a temporal arachnoid cyst, this unusual association could possibly be owing to the effect of increased pressure in the posterior fossa from massive shift of brain tissue posteriorly following a rapid rise in middle cranial fossa pressure consequent on an acute enlargement of the cyst. A false impression of acute meningeal irritation in such a situation could be quite misleading, resulting in late diagnosis and subsequently a delay in timely intervention.
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Affiliation(s)
- Chiazor U Onyia
- Department of Surgery, Lagoon Hospitals Group, Lagos, Nigeria.
| | | | - Adebayo Olaitan
- Department of Anaesthesia, Lagoon Hospitals Group, Lagos, Nigeria
| | - Chimezie Agoha
- Department of Surgery, Lagoon Hospital, Apapa, Lagos, Nigeria
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A Review on the Effectiveness of Surgical Intervention for Symptomatic Intracranial Arachnoid Cysts in Adults. World Neurosurg 2019; 123:e259-e272. [DOI: 10.1016/j.wneu.2018.11.149] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 01/28/2023]
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Vitali M, Cattalani A, Grasso VM, Bertuccio A, Barbanera A. Endoscopic fenestration of a posterior fossa arachnoid cyst to treat a Chiari-like headache. J Neurosurg Sci 2018; 63:743-744. [PMID: 29327862 DOI: 10.23736/s0390-5616.18.04288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Matteo Vitali
- Neurosurgical Unit, Surgical Department, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Andrea Cattalani
- Neurosurgical Unit, Surgical Department, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy - .,Department of Clinical Surgical, Diagnostic and Pediatric Sciences, Neurosurgery, University of Pavia, Pavia, Italy
| | - Vincenzo M Grasso
- Neurosurgical Unit, Surgical Department, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alessandro Bertuccio
- Neurosurgical Unit, Surgical Department, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Andrea Barbanera
- Neurosurgical Unit, Surgical Department, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Ros López B, Martín Gallego Á, Iglesias Moroño S. Quistes aracnoideos del sistema nervioso central. Algoritmos y recomendaciones generales de manejo. Neurocirugia (Astur) 2016; 27:67-74. [DOI: 10.1016/j.neucir.2015.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/07/2015] [Indexed: 12/14/2022]
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Hue SB, Seong HY, Kwon SC, Lyo IU, Sim HB. Syringomyelia Associated with a Huge Retrocerebellar Arachnoid Cyst: A Case Report. KOREAN JOURNAL OF SPINE 2015; 12:156-9. [PMID: 26512273 PMCID: PMC4623173 DOI: 10.14245/kjs.2015.12.3.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/26/2015] [Accepted: 09/04/2015] [Indexed: 11/19/2022]
Abstract
Occasionally, a posterior fossa arachnoid cyst can induce compression of the spinal cord and cause syringomyelia. Here, we report the case of a 29-year-old man with both progressive shoulder pain and gait disturbance, who was found to have a huge retrocerebellar arachnoid cyst associated with syringomyelia. Accordingly, posterior fossa decompression and arachnoid cyst excision were performed. Post-operative MRI showed a marked reduction in the size of the arachnoid cyst and syringomyelia. The patient's symptoms were clearly improved compared to before surgery. In our view, treatment in such patients should focus on decompressing the foramen magnum and include the removal of the coexistent arachnoid cyst walls, which appear to be the crucial factor in development of syringomyelia. In this report, we discuss the pathogenic mechanisms underlying syringomyelia-associated retrocerebellar arachnoid cyst and review the current literature on this topic.
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Affiliation(s)
- Sung Baek Hue
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Han Yu Seong
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soon Chan Kwon
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - In Uk Lyo
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hong Bo Sim
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Abstract
Arachnoid cysts are malformed lesions that contain a fluid similar to the cerebrospinal fluid, and are usually located within the arachnoidal membrane. They represent 1% of all intracranial lesions, and in recent years, with the development of radiological techniques, the clinical detectability of arachnoid cysts seems to have increased. Although the majority of diagnosed arachnoid cysts are located in the cranial cavity and especially in the Sylvian fissure, a small number are located at spinal level and they can occur extra- or intra-spinally. An analysis is carried out, detailing the various tests used for the diagnosis of both intracranial and spinal arachnoids cysts, analysing the indications of each one depending on the location of the cysts and patient age.
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Winston KR, Stence NV, Boylan AJ, Beauchamp KM. Upward Translation of Cerebellar Tonsils following Surgical Expansion of Supratentorial Cranial Vault: A Unified Biomechanical Explanation of Chiari Type I. Pediatr Neurosurg 2015; 50:243-9. [PMID: 26367858 DOI: 10.1159/000437146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/23/2015] [Indexed: 11/19/2022]
Abstract
Cerebellar tonsils moved significantly upward in 3 patients with Chiari type I who underwent supratentorial cranial vault expansion to alleviate intracranial pressure related to multisutural craniosynostosis. The Chiari type I deformities in these patients were the biomechanical consequence of posterior fossa-cerebellar disproportion caused by supratentorial craniocerebral disproportion secondary to multisutural craniosynostosis. The authors postulate that all cases of Chiari type I deformity share the sine qua non feature of posterior fossa-cerebellar disproportion.
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Killeen T, Tromop-VAN-Dalen C, Alexander H, Wickremesekera A. Bilateral retrocerebellar arachnoid cysts exerting mass effect and associated with cerebellar tonsillar ectopia in an otherwise healthy adult. Neurol Med Chir (Tokyo) 2013; 53:266-9. [PMID: 23615422 DOI: 10.2176/nmc.53.266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rarely, midline or unilateral posterior fossa arachnoid cysts (ACs) exert local mass effect resulting in the symptoms and signs of cerebellar and brainstem dysfunction. These cysts are sometimes seen in conjunction with cerebellar tonsillar ectopia (TE), although the relationship between these two entities is unclear. Bilateral ACs in the posterior fossa are virtually unprecedented. We describe the case of a 33-year-old man with a history of multiple minor head injuries observed to harbour asymptomatic, bilateral cerebrospinal fluid-density collections over the cerebellar hemispheres. Six years later, he presented with headaches, limb paraesthesias, and drop attacks. Computed tomography, magnetic resonance imaging, and operative findings during burrhole drainage of the lesions showed bilateral posterior fossa ACs, with associated cerebellar TE of 11 mm. The cysts partially recurred, necessitating reopening of the burrholes, after which the patient's symptoms resolved entirely. We then discuss the challenges in diagnosing this unusual case, the relationship between AC and TE, and the role of minor head injury in the symptomatic progression of AC.
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Affiliation(s)
- Tim Killeen
- Department of Neurosurgery, Wellington Regional Hospital, Wellington, New Zealand.
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Massimi L, Pravatà E, Tamburrini G, Gaudino S, Pettorini B, Novegno F, Colosimo C, Di Rocco C. Endoscopic third ventriculostomy for the management of Chiari I and related hydrocephalus: outcome and pathogenetic implications. Neurosurgery 2012; 68:950-6. [PMID: 21221038 DOI: 10.1227/neu.0b013e318208f1f3] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Hydrocephalus affects 7% to 10% of patients with Chiari I malformation (CIM). It can be successfully treated by endoscopic third ventriculostomy (ETV), possibly improving related CIM and syringomyelia. OBJECTIVE To confirm the effectiveness of ETV in the management of Chiari-related hydrocephalus and symptoms and to estimate the posterior cranial fossa volume (PCFV) to find the possible reasons for the success or failure of ETV. METHODS Fifteen patients (11 children and 4 adults) underwent ETV for hydrocephalus associated with CIM (syringomyelia was present in 6 patients). Preoperative PCFV, posterior fossa brain volume (PFBV), and PFBV/PCFV ratio were calculated in the last 12 patients in the series by a magnetic resonance imaging-based computerized method. RESULTS All patients had symptomatic hydrocephalus (mean third ventricle diameter, 14.1 mm). Mean tonsillar ectopia was 12.7 mm. Postoperatively, hydrocephalus symptoms improved in all cases (mean third ventricle diameter, 8.3 mm); signs and symptoms of CIM and syringomyelia resolved or improved in all patients, although the malformation remained radiologically stable in half of the patients (postoperative mean tonsillar ectopia, 8.8 mm). There were no remarkable differences between cases and controls with regard to PCFV and PFBV. The PFBV/PCFV ratio was comparable in pediatric cases and controls but not among adult patients, suggesting a PCF overcrowding in the controls. CONCLUSION ETV is an effective treatment for hydrocephalus associated with CIM. It is successful in improving CIM and syringomyelia in patients with no overcrowding (mainly in children) or with reversible overcrowding of the PCF (mainly in adults).
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Affiliation(s)
- Luca Massimi
- Institute of Neurosurgery, A. Gemelli Hospital, Rome, Italy.
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Apok V, Constantini S, Roth J. Microsurgical fenestration of retrocerebellar cysts as a treatment for syringomyelia. Childs Nerv Syst 2012; 28:653-6. [PMID: 22147240 DOI: 10.1007/s00381-011-1652-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 11/28/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Vino Apok
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Manchester, UK
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Abstract
The diagnosis of Chiari type I malformation (CIM) is more and more frequent in clinical practice due to the wide diffusion of magnetic resonance imaging. In many cases, such a diagnosis is made incidentally in asymptomatic patients, as including children investigated for different reasons such as mental development delay or sequelae of brain injury. The large number of affected patients, the presence of asymptomatic subjects, the uncertainties surrounding the pathogenesis of the malformation, and the different options for its surgical treatment make the management of CIM particularly controversial.This paper reports on the state of the art and the recent achievements about CIM aiming at providing further information especially on the pathogenesis, the natural history, and the management of the malformation, which are the most controversial aspects. A historial review introduces and explains the current classification. Furthermore, the main clinical, radiological, and neurophysiological findings of CIM are described to complete the picture of this heterogeneous and complex disease.
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Affiliation(s)
- L Massimi
- Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy
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Galarza M, López-Guerrero AL, Martínez-Lage JF. Posterior fossa arachnoid cysts and cerebellar tonsillar descent: short review. Neurosurg Rev 2010; 33:305-14; discussion 314. [PMID: 20480382 DOI: 10.1007/s10143-010-0262-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 03/07/2010] [Accepted: 03/08/2010] [Indexed: 01/08/2023]
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SUYAMA K, UJIFUKU K, HIRAO T, TAKAHATA H, ITO M, YONEKURA M, NAGATA I. Symptomatic Syringomyelia Associated With a Dermoid Tumor in the Posterior Fossa -Case Report-. Neurol Med Chir (Tokyo) 2009; 49:434-7. [PMID: 19779293 DOI: 10.2176/nmc.49.434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kazuhiko SUYAMA
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Kenta UJIFUKU
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Tomohito HIRAO
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Masahiro ITO
- Department of Pathology, Nagasaki Medical Center
| | | | - Izumi NAGATA
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences
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KOJIMA A, MAYANAGI K, OKUI S. Progression of Pre-existing Chiari Type I Malformation Secondary to Cerebellar Hemorrhage -Case Report-. Neurol Med Chir (Tokyo) 2009; 49:90-2. [DOI: 10.2176/nmc.49.90] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Martínez-Lage JF, Ruiz-Espejo A, Guillén-Navarro E, Almagro MJ. Posterior fossa arachnoid cyst, tonsillar herniation, and syringomyelia in trichorhinophalangeal syndrome Type I. J Neurosurg 2008; 109:746-50. [PMID: 18826365 DOI: 10.3171/jns/2008/109/10/0746] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report the case of a patient with Chiari malformation Type I (CM-I) and syringomyelia probably caused by a retrocerebellar arachnoid cyst. The patient's phenotype corresponded to trichorhinophalangeal syndrome Type I. The authors attributed the origin of both the retrocerebellar cyst and the abnormal posterior fossa to endochondral ossification anomalies that occur in this syndrome. The patient's spinal pain was most likely a result of the combination of CM-I and syringomyelia. To the best of the authors' knowledge, this is the first report on the association of CM-I and syringomyelia with a retrocerebellar arachnoid cyst occurring in a patient with trichorhinophalangeal syndrome Type I. The authors discuss the pathogenetic mechanisms involved in the production of tonsillar descent and syringomyelia in this patient, and review the current literature on related conditions that can result in this association.
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Affiliation(s)
- Juan F. Martínez-Lage
- 1Regional Service of Neurosurgery and
- 2Clinical and Experimental Neurosciences Group, University of Murcia Medical School, Campus de Espinardo, Murcia, Spain
| | | | - Encarna Guillén-Navarro
- 2Clinical and Experimental Neurosciences Group, University of Murcia Medical School, Campus de Espinardo, Murcia, Spain
- 3Unit of Medical Genetics, Virgen de la Arrixaca University Hospital, El Palmar; and
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