A novel technique to treat acquired Chiari I malformation after supratentorial shunting.
OBJECTIVE
The acquired Chiari I malformation with abnormal cranial vault thickening is a rare late complication of supratentorial shunting. It poses a difficult clinical problem, and there is debate about the optimal surgical strategy. Some authors advocate supratentorial skull enlarging procedures while others prefer a normal Chiari decompression consisting of a suboccipital craniectomy, with or without C1 laminectomy and dural patch grafting.


METHODS
We illustrate three cases of symptomatic acquired Chiari I malformation due to inward cranial vault thickening.


RESULTS
We describe a new surgical approach that appears to be effective in these patients. This approach includes the standard Chiari decompression combined with posterior fossa augmentation by thinning the occipital planum.


CONCLUSIONS
Internal volume re-expansion of the posterior fossa by thinning the occipital planum appears to be an effective novel surgical strategy in conjunction with the standard surgical therapy of Chiari decompression.
Department of Neurosurgery, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. a.r.e.potgieser@umcg.nl.
Adriaan R E
AR
Potgieser
Department of Neurosurgery, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
Eelco W
EW
Hoving
D000293:Adolescent; D001139:Arnold-Chiari Malformation / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects* / Q000639:trends; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000379:methods*
Acquired Chiari I malformation; Cranial vault thickening; Ventriculoperitoneal shunt