Chiari malformation type I with concomitant persistent trigeminal artery -- report of an unusual case and a review of the current literature.
BACKGROUND
Chiari malformation type I is a stenosis of the subarachnoid space at the level of the foramen magnum due to a small posterior fossa and herniation of the cerebellar tonsils. We present here the unusual case of a Chiari malformation in conjunction with a persistent trigeminal artery and hypoplasia of the basilar artery, also known as a Saltzman anomaly.


METHODS
A 34-year-old female physician presented with recurrent headaches, bilateral weakness of deltoid muscles and numbness of the fingertips 3 to 5. A cranial MRI revealed a descent of the cerebellar tonsils to the level of C2 and a supracerebellar cyst. During surgery, a decompressive suboccipital craniectomy was performed. The supracerebellar cyst was fenestrated and the cerebellar tonsils were resected bilaterally. Two days after surgery the patient developed cranial nerve dysfunction and a right-sided hemiparesis. Cerebral angiography revealed a Saltzman type 1 anomaly with persistent primitive trigeminal artery and hypoplasia of the basilar artery.


CONCLUSIONS
This is the first report in the literature about the coincidence of both unusual anomalies. The latest literature of both rare anatomy and the unusual clinical course will be discussed.
Oertel
M
M
Department of Neurosurgery, University Hospital Giessen, Giessen, Germany. matthias.oertel@neuro.med.uni-giessen.de
Kästner
S
S
Winking
M
M
Böker
D-K
DK
Deinsberger
W
W
D000328:Adult; D001139:Arnold-Chiari Malformation / Q000473:pathology* / Q000601:surgery*; D001158:Arteries / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D001488:Basilar Artery / Q000002:abnormalities / Q000473:pathology; D002533:Cerebral Angiography; D003560:Cysts / Q000601:surgery; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures; D010291:Paresis; D011183:Postoperative Complications / Q000503:physiopathology