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2019, Number 2

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Rev Cubana Neurol Neurocir 2019; 9 (2)

Management of Chiari type I malformation with posterior fossa craniectomy decompression supported by intraoperative ultrasound

Rojas MYF, Zaldívar SM, Aguilera CAB, García JCD, García RK

Language: Spanish
References: 21
Page: 1-8
PDF size: 361.14 Kb.


ABSTRACT

Objective: To describe the intraoperative utility of ultrasonography in decompressing the posterior fossa in the Chiari type I malformation surgery.
Case report: An 11-year old male patient went to the neurosurgery service at Octavio de la Concepción de la Pedraja University Pediatric Hospital in Holguín accompanied by his parents. They reported that approximately four months ago the child had lost acute consciousness, and he began with oppressive occipital headaches. Two months after the beginning of the first manifestations, he had involuntary movements in the legs, and difficulty swallowing solid foods. The physical examination showed fasciculations in the tongue, bilateral dysmetry at right predominance, dysdiadocokinesia, Romberg with lateralization to the right, osteotendinous reflexes increased to crural predominance, with right patellar clone and left ankle, right Babinski. Magnetic resonance imaging of the skull showed a decrease in cerebellar tonsils, through the great hole, and Chiari type I malformation was diagnosed. He underwent surgical treatment, decompression of the posterior fossa by craniectomy without duroplasty, supported by intraoperative ultrasound. The patient evolved favorably.
Conclusions: Intraoperative ultrasound provided information on cerebrospinal fluid (CSF) circulation through the cranioespinal junction, which allowed the surgical team not to perform the dural opening and the patient had a satisfactory evolution.


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