Coexistent Supratentorial and Infratentorial Subdural Hygromas with Hydrocephalus After Chiari Decompression Surgery: Review of Literature.
BACKGROUND
Foramen magnum decompression (FMD) is the standard procedure for Chiari I malformation. Although seemingly a straightforward procedure, recent articles have reported an increase in various complications. We describe a rare complication of coexistent supratentorial and infratentorial subdural hygromas (SDHs) with hydrocephalus noted after FMD and provide a detailed review of the literature on this topic.


METHODS
A 34-year-old woman presented with strain-related suboccipital headache and myelopathy for 6 months. Imaging revealed tonsillar herniation up to C2 level and cervical syringomyelia. A standard FMD, C1 posterior arch removal, and tonsillar reduction was performed. After an initial uneventful postoperative course, she had 2 readmissions with headache, vomiting, and ataxia. Imaging showed a tense pseudomeningocele and concomitant supratentorial and infratentorial (initially right-sided, followed by left-sided) SDHs with ventriculomegaly. She was conservatively managed with antiedema measures and had excellent relief of symptoms. For the literature review, only cases with concomitant supratentorial and infratentorial SDHs with hydrocephalus were searched online and analyzed.


RESULTS
Including ours, 10 cases have been reported. Mean age was 25.3 years. The male-to-female ratio was 1:2.3. Symptoms appeared an average of 12.6 days postoperatively. Treatment was with conservative management in 3 cases, and 3 cases required permanent cerebrospinal fluid diversions. Mean follow-up duration was 9.4 months (range, 1-27 months).


CONCLUSIONS
Coexistent supratentorial and infratentorial SDHs with hydrocephalus after Chiari decompression is a very rare occurrence. Treatment needs to be individualized based on the predominant symptomatic lesion, and surgical options need to be judiciously considered. Good prognosis is the rule in most cases.
Department of Neurosurgery, Kasturba Medical College, Manipal University, Manipal, India. Electronic address: lakshmi.prasad@manipal.edu.
G Lakshmi
GL
Prasad
Department of Neurosurgery, Kasturba Medical College, Manipal University, Manipal, India.
Girish R
GR
Menon
D000293:Adolescent; D000328:Adult; D001139:Arnold-Chiari Malformation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D056424:Decompressive Craniectomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005539:Foramen Magnum / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D013353:Subdural Effusion / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D016896:Treatment Outcome; D055815:Young Adult
Chiari I malformation; Foramen magnum decompression; Hydrocephalus; Infratentorial; Subdural hygroma; Supratentorial