title: Reformation of the posterior atlanto-occipital membrane following posterior fossa decompression with subsequent constriction at the craniocervical junction.
abstract: The posterior atlanto-occipital membrane (PAO) contributes little to craniocervical stability and is generally underappreciated and incised with most suboccipital craniectomies. We report a case of a child who underwent posterior fossa decompression for Chiari I malformation with syringomyelia whose symptoms had not resolved months after surgery. A secondary exploratory operation revealed a healed constricting PAO which had been incised linearly at the initial operation. This patient's symptoms improved soon after the second surgery. We propose that attention be given to this membrane, and if it is incised with underlying dura mater as in a standard posterior fossa decompression, it should be removed or cauterized separately and laterally to inhibit its reformation.
authors.affiliation: Department of Cell Biology, University of Alabama at Birmingham, Birmingham, Ala, USA. Richard.tubbs@ccc.uab.edu
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.forename: John C
authors.initials: JC
authors.lastname: Wellons
authors.forename: W Jerry
authors.initials: WJ
authors.lastname: Oakes
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Blount
mesh_terms: D001139:Arnold-Chiari Malformation / Q000601:surgery*; D001269:Atlanto-Occipital Joint / Q000601:surgery*; D002574:Cervical Vertebrae / Q000601:surgery*; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008566:Membranes / Q000601:surgery; D011183:Postoperative Complications; D012086:Reoperation