Resolution of acquired tonsillar herniation after resection of supratentorial meningioma

St, Onesti; Ashkenazi, Ely; Am, Miller; Wj, Michelsen

doi:10.3171/jns.1997.86.3.0572

Cited by 26 publications

(8 citation statements)

References 5 publications

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“…Acquired CMI associated syringomyelia caused by supratentorial mass is extremely rare. [ 9 , 10 , 16 , 23 ] CMI with syringomyelia may produce clinical symptoms earlier than primary lesion with secondary CMI. [ 24 ] Interestingly, Morioka et al .…”

Section: Discussionmentioning

confidence: 99%

Acquired Chiari malformation Type I and holocord syringomyelia associated with a high-flow supratentorial fistulous arteriovenous malformations: A case report and literature review

Iampreechakul

Wangtanaphat

Hangsapruek

et al. 2022

Surgical Neurology International

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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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Section: Discussionmentioning

confidence: 99%

Acquired Chiari malformation Type I and holocord syringomyelia associated with a high-flow supratentorial fistulous arteriovenous malformations: A case report and literature review

Iampreechakul

Wangtanaphat

Hangsapruek

et al. 2022

Surgical Neurology International

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“…A further MRI scan at this stage demonstrated a flow void at the Hydrocephalus is an unusual though well-recognised association with the Chiari I malformation and it is the hydrocephalus that demands treatment in the first instance, traditionally by means of a shunting procedure. The resolution of tonsillar herniation following the removal of mass lesions in the supratentorial compartment has been described previously [1,2]; moreover, following successful treatment of vein of Galen aneurysms, tonsillar herniation may also improve [3]. We are not aware of a previous demonstration of reversible tonsillar herniation following the endoscopic treatment of hydrocephalus.…”

mentioning

confidence: 81%

Resolution of Tonsillar Herniation following EndoscopicThird Ventriculostomy

Grieve

Thompson²

2001

Pediatr Neurosurg

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“…Diseases with a constrained volume of the cranial cavity include Paget's disease of bone, rickets, craniosynostosis, and erythroid hyperplasia [36][37][38][39]. Conditions that cause increase in the volume of intracranial contents and induce tonsillar descent are supratentorial and infratentorial mass lesions [40,41]. Tonsillar herniation is a usual finding in cases of rapidly enlarging intracranial processes such as acute brain edema, intracerebral hemorrhage, and evolving hydrocephalus ( Table 2).…”

Section: Etiologymentioning

confidence: 99%

What Differences Exist in the Appropriate Treatment of Congenital Versus Acquired Adult Chiari Type I Malformation?

Ramón

Gonzáles-Mandly

Pascual

2011

Curr Pain Headache Rep

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Chiari type I malformation is found in 1 out of 20 magnetic resonance imaging (MRI) studies. Isolated tonsillar herniation is of limited utility and should be considered within the clinical context because these patients can be asymptomatic. Cine MRI showing compression of the cerebrospinal fluid (CSF) spaces in the foramen magnum area is a crucial technique for making treatment decisions. Congenital malformation is thought to be due to a volumetric small posterior fossa. The most common symptom in these patients is cough headache. Posterior fossa reconstruction is mandatory in patients with progressive symptoms/signs, hydrocephalus, or syringomyelia, but not in patients who are asymptomatic or those with stable and tolerable symptoms. Acquired tonsillar descent can be secondary to a variety of disorders conditioning disproportion between the volume of the cranial cavity and that of the intracranial contents, or to CSF hypovolemia, which is the most common cause for acquired herniation. CSF hypovolemia can be spontaneous or secondary to CSF removal. Treatment of acquired tonsillar herniation depends on the responsible etiology.

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Resolution of acquired tonsillar herniation after resection of supratentorial meningioma

Cited by 26 publications

References 5 publications

Acquired Chiari malformation Type I and holocord syringomyelia associated with a high-flow supratentorial fistulous arteriovenous malformations: A case report and literature review

Acquired Chiari malformation Type I and holocord syringomyelia associated with a high-flow supratentorial fistulous arteriovenous malformations: A case report and literature review

Resolution of Tonsillar Herniation following EndoscopicThird Ventriculostomy

What Differences Exist in the Appropriate Treatment of Congenital Versus Acquired Adult Chiari Type I Malformation?

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