Subacute Subdural Hygroma and Presyrinx Formation After Foramen Magnum Decompression With Duraplasty for Chiari Type 1 Malformation -Case Report-

Abstract

A 15-year-old girl developed a rare case of subdural hygroma after foramen magnum decompression for Chiari type 1 malformation manifesting as rapid symptom deterioration around 10 days after uncomplicated operation with uneventful immediate postoperative course. Progressive enlargement of the subdural hygroma in both supra-and infratentorial spaces was followed by the development of hydrocephalus. Syringomyelia improved shortly after the first operation but then deteriorated with massive presyrinx formation. Reoperation with wide opening of the arachnoid membrane lead to a rapid resolution of the hydrocephalus and the presyrinx. The present case shows that wide opening of the arachnoid membrane is an effective therapeutic option.

Management of hydrocephalus and subdural hygromas in pediatric patients after decompression of Chiari malformation type I: case series and review of the literature

“…4,5,10,17 There is much debate regarding the surgery for CM-I decompression, such as whether to perform bony decompression alone or to include additional steps, such as duraplasty, opening the arachnoid, or tonsillar cautery. 2,8,10,18,27 Delayed postoperative subdural hygromas and acute hydrocephalus after CM-I decompression are rare complications but have been previously discussed in the literature. Most of the known literature focuses on the adult population.…”

“…20 Subdural hygromas and postoperative hydrocephalus after posterior fossa decompression are rare but recognized complications without a consensus for management. [4][5][6]9,11,19,23,24,26,27,31 A variety of treatments have been described, including temporary CSF diversion, permanent CSF diversion, endoscopic third ventriculostomy (ETV), reoperation to widen the arachnoidal opening, and evacuation of subdural hygromas. 24,27,31 There are rare reports of good outcomes after nonoperative management.…”

“…[4][5][6]9,11,19,23,24,26,27,31 A variety of treatments have been described, including temporary CSF diversion, permanent CSF diversion, endoscopic third ventriculostomy (ETV), reoperation to widen the arachnoidal opening, and evacuation of subdural hygromas. 24,27,31 There are rare reports of good outcomes after nonoperative management. 9,11,19 We present our experience with 5 pediatric patients at 2 institutions and discuss nonoperative strategies for treatment.…”

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

“…[1][2][3][4]6,7 The patients generally developed symptoms 3-15 days after the surgery. In all of them the original surgery included opening the dura, and in many of them an attempt was made to leave the arachnoid intact and a small pinhole leak in the arachnoid was noted at surgery.…”

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

“…13,14) Review of indexed literature yielded 10 previous reports of symptomatic EH, i.e., a combination of infra- or supratentorial SFCs and internal hydrocephalus complicating FMD. 11,14–18) Nine of these 10 cases were arachnoid-sparing FMDs, and a tiny breach at the arachnoid-dural interface was held responsible for the development of high-pressure subdural collection(s). Torquing or compression of the aqueduct by the infratentorial SFC was implicated to be the cause of the hydrocephalus in these cases.…”