title: Improvement of obstructive sleep apneas caused by hydrocephalus associated with Chiari malformation Type II following surgery.
abstract: Chiari malformation (CM) is the downward herniation of the caudal part of the cerebellum and/or medulla oblongata into the spinal canal. It can alter several neurological functions, including respiratory control and upper airway motility, and can be the cause of sleep-disordered breathing (SDB). The authors describe a 6-year-old boy affected by CM Type II associated with myelomeningocele who showed symptoms indicative of severe airway obstruction during sleep. Polysomnography revealed severe obstructive sleep apnea syndrome (OSAS). Magnetic resonance imaging demonstrated herniation of the cerebellar tonsils and diffuse ventricular dilation with a large pseudocystic formation in the third ventricle. Surgical marsupialization of the cystic wall was performed, associated with ventriculocystostomy and endoscopic replacement of the ventricular catheter. Polysomnography repeated 2 months after surgery revealed a striking improvement in the sleep-related respiratory pattern. The pathogenesis of OSAS was probably referable to a combination of CM and elevated intracranial pressure. However, the striking improvement of symptoms after ventriculoatrial shunt placement suggested that hydrocephalus plays a major role in this condition. Assessment and effective treatment of SDB is crucial in the care of patients with CM.
authors.affiliation: Department of Neurosciences, Catholic University of Sacred Heart, Rome, Italy. mluigetti@gmail.com
authors.forename: Marco
authors.initials: M
authors.lastname: Luigetti
authors.forename: Anna
authors.initials: A
authors.lastname: Losurdo
authors.forename: Serena
authors.initials: S
authors.lastname: Dittoni
authors.forename: Elisa
authors.initials: E
authors.lastname: Testani
authors.forename: Salvatore
authors.initials: S
authors.lastname: Colicchio
authors.forename: Valentina
authors.initials: V
authors.lastname: Gnoni
authors.forename: Benedetto
authors.initials: B
authors.lastname: Farina
authors.forename: Emanuele
authors.initials: E
authors.lastname: Scarano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Zampino
authors.forename: Paolo
authors.initials: P
authors.lastname: Mariotti
authors.forename: Claudia
authors.initials: C
authors.lastname: Rendeli
authors.forename: Concezio
authors.initials: C
authors.lastname: Di Rocco
authors.forename: Luca
authors.initials: L
authors.lastname: Massimi
authors.forename: Giacomo
authors.initials: G
authors.lastname: Della Marca
mesh_terms: D001139:Arnold-Chiari Malformation / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D002648:Child; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008591:Meningomyelocele / Q000150:complications / Q000473:pathology / Q000601:surgery; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome