Chiari malformation presenting with pseudotumor cerebri: what is the best treatment?

Resolution of papilledema associated with chiari I malformation with ventriculoperitoneal shunting

“…The neurosurgical literature contains many cases of successful management of papilledema secondary to CMI with PFD; however, no randomized trials have been performed comparing PFD and VPS. [9][10][11][12][13] While PFD is successful in many retrospective case series of patients with CMI and papilledema, recurrence of symptoms or papilledema postoperatively has also been reported. Five patients described by Alnemari et al underwent PFD for CMI but experienced a recurrence of symptoms within days to 3 years postoperatively despite restoration of CSF flow at the craniocervical junction.…”

“…The potential morbidity associated with acute brainstem herniation from lumbar punctures or lumboperitoneal shunting procedures among patients with CMI must be emphasized; however, VPS is unlikely to cause this dreaded complication because the site of diversion is rostral to CMI. [12,13] Through successful management with VPS alone, the patient avoided a prolonged postoperative recovery and the additional surgical morbidity/risk of complications with PFD, particularly when ICP is elevated, as well as a longer postoperative recovery. [15,16] PFD remains a surgical option should our patient experience a recurrence of symptoms in the future.…”