Delayed pseudomyelomeningocele: a rare complication after foramen magnum decompression for Chiari malformation
Surgical Neurology, cilt.71, sa.3, ss.357-361, 2009 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 71 Sayı: 3
- Basım Tarihi: 2009
- Doi Numarası: 10.1016/j.surneu.2007.08.031
- Dergi Adı: Surgical Neurology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Sayfa Sayıları: ss.357-361
- Anahtar Kelimeler: Arachnoiditis, Chiari malformation, Foramen magnum, Pseudomyelomeningocele, Spinal cord, Syringomyelia
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: A variety of complications after FMD with or without duraplasty for Chiari malformation have been described. Although cerebellar ptosis through the dural opening and pseudomeningocele are well-known rare complications of this procedure, spinal cord herniation manifesting as pseudomyelomeningocele formation has not previously been cited in the literature. In this report, we present a case of delayed pseudomyleomeningocele after FMD. Case Description: A 22-year-old man presented with progressive spinal cord compression symptoms 7 years after undergoing FMD for Chiari malformation. Craniocervical MRI of the patient revealed pseudomyelomeningocele at C1 level together with cord distortion. The patient underwent untethering surgery for spinal cord adhesions; neural tissue was freed microsurgically from the adjacent structures and duraplasty was performed with synthetic graft. In the early postoperative period, his symptoms resolved moderately. Conclusion: Neural tissue shift including the spinal cord through the dural opening may occur after a large posterior fossa decompression without duraplasty for Chiari malformation. Postoperative inadequate CSF circulation due to arachnoid scarring around the decompression area may facilitate this type condition. Early diagnosis of such a complication is of vital importance to prevent serious neurologic deficits, and release surgery with proper duraplasty and also restoration of CSF circulation is the choice of treatment. © 2009 Elsevier Inc. All rights reserved.