title: The use of the trendelenburg position in the surgical treatment of extreme cerebellar slump.
abstract: BACKGROUND
  State-of-the-art treatment for Chiari Malformation I (CM-I) consists of decompression by posterior fossa craniectomy. A rare but severe complication that develops over months to years after this procedure is cerebellar slump. Treatment options for this condition are limited. We present a new and promising approach to treat this rare condition.
  
  
  METHODS
  The patients were placed in the Trendelenburg position to facilitate ascent of the cerebellum. After almost complete dissolution of neurologic symptoms, surgical reconstruction was performed by tonsillar resection and the creation of a new structural support using a bone graft.
  
  
  RESULTS
  Both patients experienced good clinical and morphological outcomes immediately after surgery, and for two years thereafter.
  
  
  CONCLUSIONS
  Neurological symptoms related to cerebellar or brainstem slump can be adequately reversed by placing the patient in the Trendelenburg position. After uneventful gravitational reversal of the slump, safe surgical reconstruction of the cerebellar support can be performed to securely preserve the anatomical reversal.
authors: a Department of Neurosurgery , Ghent University Hospital , Ghent , Belgium.
authors: Frank
authors: F
authors: Dewaele
authors: b Department of Anesthesiology and Intensive Care Medicine , Maria Middelares Hospital , Ghent , Belgium and Department of Anesthesiology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.
authors: Alain F
authors: AF
authors: Kalmar
authors: a Department of Neurosurgery , Ghent University Hospital , Ghent , Belgium.
authors: Edward
authors: E
authors: Baert
authors: c Department of Mechanics , University College Ghent , Belgium.
authors: Annemieke
authors: A
authors: Van Haver
authors: a Department of Neurosurgery , Ghent University Hospital , Ghent , Belgium.
authors: Giorgio
authors: G
authors: Hallaert
authors: d Department of Industrial Technology and Construction , University Ghent , Belgium.
authors: Frank
authors: F
authors: De Mets
authors: e Department of Psychiatry , Wotton Lawn Hospital , Gloucester, Gloucestershire , UK.
authors: Leonie
authors: L
authors: Williams
authors: a Department of Neurosurgery , Ghent University Hospital , Ghent , Belgium.
authors: Jean Pierre
authors: JP
authors: Kalala Okito
authors: f Department of Neurology , Ghent University Hospital , Ghent , Belgium.
authors: Koen
authors: K
authors: Paemeleire
authors: a Department of Neurosurgery , Ghent University Hospital , Ghent , Belgium.
authors: Jacques
authors: J
authors: Caemaert
authors: a Department of Neurosurgery , Ghent University Hospital , Ghent , Belgium.
authors: Dirk
authors: D
authors: Van Roost
mesh_terms: D000328:Adult; D001139:Arnold-Chiari Malformation / Q000175:diagnosis / Q000601:surgery*; D002531:Cerebellum / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods; D004388:Dura Mater / Q000601:surgery*; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures; D013595:Syringomyelia / Q000175:diagnosis / Q000601:surgery*
keywords: Trendelenburg; brainstem; cerebellar; slump