title: Anomalous venous drainage preventing safe posterior fossa decompression in patients with chiari malformation type I and multisutural craniosynostosis. Report of two cases and review of the literature.
abstract: The authors report on two children in whom an anomalous posterior fossa venous drainage pattern prevented safe posterior fossa decompression. Both patients had Chiari malformation Type I, multisutural craniosynostosis, and crowded posterior fossa structures. Both patients had been treated with ventriculoperitoneal shunts for hydrocephalus. Pfeiffer syndrome had been diagnosed in one of the patients, and the other was suspected to have osteogenesis imperfecta. Although both patients were believed to have symptoms resulting from brainstem compression, posterior fossa decompression was not offered due to profound venous anomalies noted on imaging studies that greatly increased the expected risks associated with surgery. These cases are presented to alert neurosurgeons to carefully evaluate the posterior fossa venous anatomy prior to considering posterior fossa decompression with or without occipitocervical fusion or calvarial vault remodeling procedures in patients with multisutural craniosynostosis.
authors.affiliation: Department of Neurosurgery, University of Miami Miller School of Medicine and Miami Children's Hospital, Miami, Florida 33155, USA. dsandberg@med.miami.edu
authors.forename: David I
authors.initials: DI
authors.lastname: Sandberg
authors.forename: Ramon
authors.initials: R
authors.lastname: Navarro
authors.forename: Josep
authors.initials: J
authors.lastname: Blanch
authors.forename: John
authors.initials: J
authors.lastname: Ragheb
mesh_terms: D000792:Angiography; D001139:Arnold-Chiari Malformation / Q000150:complications* / Q000175:diagnosis; D002550:Cerebral Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D002648:Child; D000075202:Contraindications; D003388:Cranial Fossa, Posterior / Q000098:blood supply* / Q000601:surgery*; D003398:Craniosynostoses / Q000150:complications* / Q000175:diagnosis; D019299:Decompression, Surgical; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D014057:Tomography, X-Ray Computed