Symptomatic subdural hygroma as a complication of foramen magnum decompression for hindbrain herniation (Arnold-Chiari deformity)

Ranjan, Abhay; Cast, I P

doi:10.1080/02688699650040188

Cited by 42 publications

(28 citation statements)

References 10 publications

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“…However, a rather large number of complications were also encountered, postoperative fever caused by aseptic meningitis being the most common complication with an incidence rate of up to 18%. The medical literature suggests that pseudomeningocele is a common complication [32, 33]. However, we did not encounter any incidence of pseudomeningocele in the present series.…”

Section: Discussioncontrasting

confidence: 51%

Surgical Management of Chiari Malformation: Analysis of 128 Cases

Guo

Wang²,

Jiang

et al. 2007

Pediatr Neurosurg

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Objective: A variety of surgical interventions have been recommended for patients with Chiari malformations (CMs). In this study, we have evaluated the intraoperative findings and clinical outcome in different-aged patients with CMs undergoing posterior fossa decompression. Methods: Sixteen pediatric and 112 adult cases with CMs underwent suboccipital craniectomy and wide duraplasty as well as autogenous bone grafting in selected cases. The clinical outcome was assessed by evaluation of postoperative signs and symptoms and magnetic resonance imaging of the craniocervical junction. Results: The most striking intraoperative finding was the presence of a very thin membrane over the opening of the central canal; the occurrence of this membrane in pediatric patients was significantly higher than that in adults (94 and 43%, respectively; p < 0.05, Fisher’s exact probability test). During the immediate postoperative period, 81% of pediatric CMs and 90% of adult CMs showed improved symptomatology and magnetic resonance imaging revealed favorable findings comprising syrinx collapse or reduction of the syrinx diameter in 14 (88%) pediatric and 92 (82%) adult CMs. During discharge from hospital, 103 (90%) patients with CMs type I and 11 (85%) with CMs type II achieved good results. However, there was a statistically significant difference in the occurrence of poor results between patients treated with bony fusion and those without fusion (24 vs. 6%;p < 0.05, Fisher’s exact probability test). The incidence of vertebral instability was markedly augmented in pediatric CMs in comparison to adult CMs (19 vs. 2%; p < 0.01, Fisher’s exact probability test). Conclusions: Suboccipital decompression and duraplasty with autogenous bone grafts in selected cases are effective treatments for most patients with CMs. A higher incidence of a special membrane over the obex and atlantoaxial instability were closely associated with childhood CMs.

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Section: Discussioncontrasting

confidence: 51%

Surgical Management of Chiari Malformation: Analysis of 128 Cases

Guo

Wang²,

Jiang

et al. 2007

Pediatr Neurosurg

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“…One series reported a pseudomeningocele rate of 12.7% [4]. We could find only one prior complication involving an infratentorial supracerebellar hygroma reported in an adult [5]. …”

Section: Discussionmentioning

confidence: 99%

Acute Hydrocephalus following a Chiari I Decompression

et al. 2002

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“…This technique had been published before with the same good result 3 . Up to date six cases of symptomatic subdural hygromas in adults have been reported by different authors 1,2,4,5 , all of them secondary to posterior fossa decompression. Five patients were treated for Chiari malformation Type I (CM-I) and one patient presented a hemangioblastoma 5 .…”

Section: Discussionmentioning

confidence: 99%

Infratentorial hygroma secondary to decompressive craniectomy after cerebellar infarction

Tejada-Solís¹,

Díez-Valle²,

Domínguez-Echavarri³

et al. 2009

Neurocirugía

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SummaryWe present a case of expansive CSF collection in the cerebellar convexity. The patient was a 74 years old lady who one month before had suffered a cerebellar infarct complicated with acute hydrocephalus. She had good evolution after decompressive craniectomy without shunting. Fifteen days after surgery, the patient started with new positional vertigo, nausea and vomiting and a wound CSF fistula that needed ventriculoperitoneal shunt (medium pressure) because conservative treatment failed. After shunting, the fistula closed, but the patient symptoms worsened. The MRI showed normal ventricular size with a cerebellar hygroma, extending to the posterior interhemispheric fissure. The collection had no blood signal and expanded during observation. A catheter was implanted in the collection and connected to the shunt. The patient became asymptomatic after surgery, and the hygromas had disappeared in control CT at one month.This case shows an infrequent problem of CSF circulation at posterior fossa that resulted in vertigo of central origin. A higroma-ventricle-peritoneal shunt solved the symptoms of the patient.KEY WORDS: Central vertigo. Infratentorial hygroma. Posterior fossa decompression. Higroma infratentorial secundario a una craniectomía descompresiva tras un infarto de cerebelo ResumenPresentamos el caso de una paciente con una colección expansiva de LCR sobre la convexidad del cerebelo. La paciente, de 74 años de edad, había sido intervenida de urgencia un mes antes por un infarto de hemisferio cerebeloso e hidrocefalia aguda, con buena evolución tras la craniectomía descompresiva de fosa posterior y sin necesitar válvula. A los 15 días de la intervención, la paciente comenzó con un cuadro de vértigo posicional, náuseas, vómitos y una fístula de LCR, que al no responder al tratamiento conservador fue tratada con una válvula VP de presión media. Tras implantar la válvula la fístula se cerró, pero el cuadro clínico de la paciente empeoró.En una resonancia magnética se objetivó un tamaño ventricular normal e higromas infratentoriales que se extendían hacia la fisura interhemisférica posterior. En los higromas no se objetivó señal de sangrado y fueron aumentando de tamaño. Se implantó un catéter a nivel del higroma de mayor tamaño en la fosa posterior y se conectó a la válvula que portaba la paciente, evolucionando de forma favorable clínica y radiológicamente. Al mes de la intervención los higromas habían desaparecido en el TAC de control.Este caso muestra una situación infrecuente de alteración del flujo de LCR a nivel de la fosa posterior que da lugar a un cuadro de vértigo de origen central. El drenaje de los higromas, mediante un catéter conectado a una válvula ventriculo peritoneal, solucionó la sintomatología.PALABRAS CLAVE: Vértigo central. Higroma infratentorial. Descompresión fosa posterior.

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Symptomatic subdural hygroma as a complication of foramen magnum decompression for hindbrain herniation (Arnold-Chiari deformity)

Cited by 42 publications

References 10 publications

Surgical Management of Chiari Malformation: Analysis of 128 Cases

Surgical Management of Chiari Malformation: Analysis of 128 Cases

Acute Hydrocephalus following a Chiari I Decompression

Infratentorial hygroma secondary to decompressive craniectomy after cerebellar infarction

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