Improvement of obstructive sleep apneas caused by hydrocephalus associated with Chiari malformation Type II following surgery.
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.
Luigetti
Marco
M
Department of Neurosciences, Catholic University of Sacred Heart, Rome, Italy. mluigetti@gmail.com
Losurdo
Anna
A
Dittoni
Serena
S
Testani
Elisa
E
Colicchio
Salvatore
S
Gnoni
Valentina
V
Farina
Benedetto
B
Scarano
Emanuele
E
Zampino
Giuseppe
G
Mariotti
Paolo
P
Rendeli
Claudia
C
Di Rocco
Concezio
C
Massimi
Luca
L
Della Marca
Giacomo
G
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