Subdural Fluid Collection and Hydrocephalus After Foramen Magnum Decompression for Chiari Malformation Type I: Management Algorithm of a Rare Complication

Zefferino Rossini, Davide Milani, Francesco Costa, Carlotta Castellani, Giovanni Lasio, Maurizio Fornari

Research output: Contribution to journalArticle

Abstract

Background Chiari malformation type I is a hindbrain abnormality characterized by descent of the cerebellar tonsils beneath the foramen magnum, frequently associated with symptoms or brainstem compression, impaired cerebrospinal fluid circulation, and syringomyelia. Foramen magnum decompression represents the most common way of treatment. Rarely, subdural fluid collection and hydrocephalus represent postoperative adverse events. The treatment of this complication is still debated, and physicians are sometimes uncertain when to perform diversion surgery and when to perform more conservative management. Case Description We report an unusual occurrence of subdural fluid collection and hydrocephalus that developed in a 23-year-old patient after foramen magnum decompression for Chiari malformation type I. Following a management protocol, based on a step-by-step approach, from conservative therapy to diversion surgery, the patient was managed with urgent external ventricular drainage, and then with conservative management and wound revision. Conclusions Because of the rarity of this adverse event, previous case reports differ about the form of treatment. In future cases, finding clinical and radiologic features to identify risk factors that are useful in predicting if the patient will benefit from conservative management or will need to undergo diversion surgery is only possible if a uniform form of treatment is used. Therefore, we believe that a management algorithm based on a step-by-step approach will reduce the use of invasive therapies and help to create a standard of care.

Original languageEnglish
Pages (from-to)1057.e9-1057.e15
JournalWorld Neurosurgery
Volume106
DOIs
Publication statusPublished - Oct 1 2017

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Keywords

  • Chiari malformation type I
  • Foramen magnum decompression complication
  • Hydrocephalus
  • Subdural hygroma

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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