Spontaneous resolution of a Chiari malformation Type I and syrinx after supratentorial craniotomy for excision of a cavernous malformation.
The pathogenesis of Chiari malformation Type I (CM-I) and associated syringomyelia is incompletely understood. Patients often present in middle age with incidental or minimally symptomatic CM-I, whose management is controversial. One option is clinical and radiographic observation of asymptomatic and minimally symptomatic patients. The authors here present the case of a 36-year-old woman who had been monitored for 6 years for a minimally symptomatic CM-I and cervicothoracic syrinx. After 5 years of follow-up, she suffered spontaneous rupture of a cerebral cavernous malformation when she was 27 weeks pregnant. The ruptured cavernous malformation and hematoma were operatively managed via a right frontal craniotomy. Ten months after the craniotomy for resection of the ruptured cavernous malformation, follow-up MRI demonstrated resolution of the CM-I and syrinx. Few similar cases have been reported in adults. This case argues for the presence of dynamic factors in the development and maintenance of CM-I and supports the nonoperative treatment of asymptomatic and minimally symptomatic patients.
Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts 20111, USA.
William R
WR
Miele
Clemens M
CM
Schirmer
Kevin C
KC
Yao
Carl B
CB
Heilman
D000328:Adult; D000767:Anesthesia, Epidural; D001139:Arnold-Chiari Malformation / Q000601:surgery*; D001931:Brain Mapping; D002531:Cerebellum / Q000473:pathology; D002585:Cesarean Section; D003399:Craniotomy; D004172:Diplopia / Q000209:etiology; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000628:therapy; D011184:Postoperative Period; D011247:Pregnancy; D012422:Rupture, Spontaneous; D013595:Syringomyelia / Q000473:pathology / Q000601:surgery*