[Treatment of syringomyelia in patients with Chiari malformation and craniosynostosis. A case report and review of the literature].
BACKGROUND
Patients with multisutural or single craniosynostosis, often suffer from Chiari malformation and syringomyelia. The surgical management of syringomyelia in these patients is controversial.


METHODS
A 3-year-old girl was referred with complex craniosynostosis that had not been corrected surgically. She was asymptomatic despite the cranial MRI showed a Chiari malformation and one year later she developed a cervico-dorso-lumbar syringomyelia. She underwent a decompressive suboccipital craniectomy but subsequently suffered a worsening of syringomyelia. The intracranial pressure monitoring was pathological so it was decided to perform a decompressive bilateral fronto-parieto-temporal craniotomy and remodeling of the cranial vault, achieving a significant reduction of syringomyelia.


CONCLUSIONS
After reviewing the literature, it is noted that there is currently no consensus on the treatment of syringomyelia in patients with craniosynostosis and Chiari malformation. Some authors recommend the simultaneous surgical suboccipital and cranial vault decompression, others only decompression of the cranial vault and other enlargement of the posterior fossa with distractors. In cases where the suboccipital decompression was performed first, the syringomyelia was not improved or stabilized. We conclude that the most effective treatment for patients with syringomyelia and craniosynostosis is decompressive remodeling of the cranial vault, as the main cause of syringomyelia is the raised intracranial pressure and lack of skull compliance.
Hospital Infantil Universitario Nino Jesus, 28009 Madrid, Espana.
A
A
Aransay-Garcia
Hospital Infantil Universitario Nino Jesus, 28009 Madrid, Espana.
F J
FJ
Villarejo-Ortega
D001139:Arnold-Chiari Malformation / Q000150:complications*; D002675:Child, Preschool; D003398:Craniosynostoses / Q000150:complications*; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures; D012886:Skull; D013595:Syringomyelia / Q000601:surgery*