Remote Cerebellar Hemorrhage After Foramen Magnum Decompression Surgery for Chiari I Malformation -Case Report-

Abstract

A 47-year-old woman underwent decompressive suboccipital craniectomy and C1 laminectomy with duroplasty in the prone position for Chiari malformation type I and syringomyelia. The arachnoid membrane was not injured. Intraoperative echography showed good enlargement of the subarachnoid space. No closed subcutaneous drain was used. The patient complained of repeated nausea and vomiting 3 hours after the operation, and computed tomography revealed remote cerebellar hemorrhage on postoperative day 1. The cerebellar hemorrhage was treated conservatively, and the symptoms continued only for 3 days after surgery. Dural opening with rapid loss of cerebrospinal fluid (CSF) has occurred in every reported case of remote cerebellar hemorrhage complicating intracranial and spinal procedures. Loss of CSF is the main pathogenesis of this condition. In our case, the most probable pathomechanism seems to involve stretching of the infratentorial cerebellar bridging veins due to cerebellar sagging because of dural opening in the prone position and drop in CSF pressure. Such a complication is rare but should be considered after foramen magnum decompression surgery if the patient shows unusual symptoms of repeated vomiting.

Chiari Malformation Type 1: A Systematic Review of Natural History and Conservative Management

“…21 The literature search found 21 papers with details on the presenting symptoms of one or more cases of CM-1. [4][5][6][8][9][10]15,16,[19][20][21][22][23][24][25][26][27][28][29][30] Of these, 13 discussed fewer than 10 patients, 6,8,10,15,16,[18][19][20]22,[25][26][27][28] with the majority of these being case reports. Four looked at between 10 and 40 patients 3,9,24,29 and three looked at over 40 patients.…”

Atypical Cerebellar Slump Syndrome and External Hydrocephalus following Craniocervical Decompression for Chiari I Malformation: Case Report

“…1) Unusual complications include external hydrocephalus (EH) i.e., the presence of ventriculomegaly in association with subdural fluid collections (SFC), symptomatic cerebellar slump (CS), pseudotumour cerebri, 3) posterior cerebral artery infarct, 3) negative pressure pulmonary edema, 4) tethering of the cervico-medullary junction, 5) and remote cerebellar hemorrhage. 6) We report a first-of-its-kind case wherein two of these unusual complications (EH and CS) occurred in atypical settings following a normal sized FMD: the EH occurred after wide arachnoid fenestration and with an enlarged rather than compressed aqueduct, and symptomatic CS occurred with concomitantly resolving syringomyelia, rather than with persisting or worsening syringomyelia. A mechanism is proposed to clarify the peculiar findings in the case.…”