Resolution of Chiari malformation after repair of a congenital thoracic meningocele: case report and literature review.
OBJECTIVE
Many theories have been proposed regarding potential causative factors for Chiari malformations. An unusual case is described in which regression of a congenital Chiari malformation was observed after repair of a thoracic meningocele without direct surgical intervention to decompress the craniocervical junction. This supports the importance of an in utero craniospinal pressure gradient as a potential cause for congenital, but reversible, cerebellar herniation.


METHODS
A newborn baby was observed to have a thoracic meningocele. Magnetic resonance imaging scan revealed a concomitant Chiari malformation. No neurological deficits were present at initial examination.


METHODS
The patient underwent surgical closure of the thoracic meningocele and untethering of the spinal cord at the site of the dural defect. A postoperative magnetic resonance imaging scan obtained 3 months after the operation revealed complete resolution of the cerebellar herniation.


CONCLUSIONS
The resolution of the Chiari malformation in this child may have resulted from restoration of normal cerebrospinal fluid flow and elimination of the meningocele-related cerebrospinal fluid pressure gradient between the intracranial and intraspinal compartments.
Madhok
Ricky
R
Department of Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Mazzola
Catherine A
CA
Pollack
Ian F
IF
D001139:Arnold-Chiari Malformation / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008588:Meningocele / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D019635:Neurosurgical Procedures; D013896:Thoracic Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*