Top

Published in:

01-05-2011 | Case Report

Management of infratentorial subdural hygroma complicating foramen magnum decompression: a report of three cases

Authors: Anuj Bahl, Mary Murphy, Nicholas Thomas, Richard Gullan

Published in: Acta Neurochirurgica | Issue 5/2011

Abstract

Decompression of the foramen magnum for symptomatic Chiari malformation attends a small but significant risk of infratentorial subdural extra-arachnoid hygroma when an arachnoid-sparing procedure is attempted. We present three cases whereby an arachnoid-sparing procedure was carried out and resulted in infratentorial subdural hygroma and hydrocephalus. The complication was managed by re-exploration of the posterior fossa and wide arachnoidotomy. In cases whereby the decision has been made to open the dura, we recommend routine arachnoidotomy in foramen magnum decompression, avoiding the risks of infratentorial subdural hygroma. In cases where arachnoid-sparing procedures have been attempted and subdural hygroma subsequently develops, we advocate re-exploration of the posterior fossa rather than cerebrospinal fluid diversion.

Alden TD, Ojema JG, Park TS (2001) Surgical treatment for Chiari I malformation: indications and approaches. Neurosurg Focus 11(1):Article 2CrossRef

Bosma J, Kumaran N, May P (2002) Cerebral oedema following EVD insertion for delayed hydrocephalus after foramen magnum decompression in Chiari I malformation. Child’s Nerv Syst 18:474–477CrossRef

Cardoso ER, Schubert R (1996) External hydrocephalus in adults. Report of three cases. J Neurosurg 85:1143–1147PubMedCrossRef

Ellenbogen RG, Zeidman SM (2000) Craniovertebral decompression for Chiari malformation. In: Kaye A, Black P (eds) Operative neurosurgery. Churchill Livingstone, London, pp 1725–1741

Elton S, Tubbs RS, Wellons JC 3rd, Blount JP, Grabb PA, Oakes WJ (2002) Acute hydrocephalus following a Chiari I decompression. Pediatr Neurosurg 36:101–104PubMedCrossRef

Filis AK, Moon K, Cohen AR (2009) Symptomatic subdural hygroma and hydrocephalus following Chiairi I decompression. Pediatr Neurosurg 45:425–428PubMedCrossRef

Klekamp J, Batzdorf U, Samii M, Bothe HW (1996) The surgical treatment of Chiari I malformation. Acta Neurochir 138(7):788–801CrossRef

Klekamp J, Iaconetta G, Batzdorf U, Samii M (2002) Syringomyelia associated with foramen magnum arachnoiditis. J Neurosurg 97(3 Suppl):317–322PubMed

Logue V, Edwards MR (1981) Syringomyelia and its surgical treatment—an analysis of 75 patients. J Neurol Neurosurg Psychiatry 44:273–284PubMedCrossRef

10.

Marshman LAG, Benjamin JC, Chawda SJ, David KM (2005) Acute obstructive hydrocephalus associated with infratentorial subdural hygromas complicating Chiari malformation type I decompression. J Neurosurg 103:752–755PubMedCrossRef

11.

Mazzola CA, Fried AH (2003) Revision surgery for Chiari malformation decompression. Neurosurg Focus 15(3):Article 3CrossRef

12.

McGirt MJ, Attenello FJ, Datoo G, Gathinji M, Atiba A, Weinagrt JD, Carson B, Jallo GI (2008) Intraoperative ultrasonography as a guide to patient selection for duraplasty after suboccipital decompression in children with Chiari malformation Type I. J Neurosurg Pediatr 2(1):52–57PubMedCrossRef

13.

Milhorat TM, Bolognese PA (2003) Tailored operative technique for Chiari I technique using intra-operative colour Doppler on US. Neurosurgery 53(4):899–906PubMedCrossRef

14.

Munshi I, Frim D, Stine-Reyes R, Weir BK, Hekmatpanan J, Brown F (2000) Effects of posterior fossa decompression with and without duraplasty on Chiari malformation-associated hydromyelia. Neurosurgery 46:1384–1389PubMedCrossRef

15.

Perrini P, Rawlinson A, Cowie RA, King AT (2008) Acute external hydrocephalus complicating craniocervical decompression for syringomyelia–Chiari I complex: case report and review of the literature. Neurosurg Rev 31(3):331–335PubMedCrossRef

16.

Pritz MB (2003) Surgical treatment of Chiari I malformation: simplified technique and clinical results. Skull Base 13(3):173–177PubMedCrossRef

17.

Ranjan A, Cast IP (1996) Symptomatic subdural hygroma as a complication of foramen magnum decompression for hindbrain herniation. Br J Neurosurg 10:301–303PubMedCrossRef

18.

Steinmetz MP, Benzel EC (2003) Surgical management of Chiari malformation. Neurosugery Quarterly 13(2):105–112CrossRef

19.

Tubbs RS, McGirt MJ, Oakes WJ (2003) Surgical experience in 130 patients with Chiari I malformations. J Neurosurg 99:291–296PubMedCrossRef

20.

Williams B (1994) A blast against grafts—on the closing and grafting of the posterior fossa dura. Br J Neurosurg 8:275–278PubMedCrossRef

Title: Management of infratentorial subdural hygroma complicating foramen magnum decompression: a report of three cases
Authors: Anuj Bahl
Mary Murphy
Nicholas Thomas
Richard Gullan
Publication date: 01-05-2011
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 5/2011
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-010-0920-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Management of infratentorial subdural hygroma complicating foramen magnum decompression: a report of three cases

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2011

Timing and minimal access surgery for sciatica: a summary of two randomized trials

Vasculature and neurovascular relationships of the trigeminal nerve root

The impact of subdural air collection on intraoperative motor and somatosensory evoked potentials: fact or myth?

Restenosis after endovascular PTA/stenting for supra-aortic branches in Takayasu aortitis: report of three cases and review of the literature

Severe traumatic pneumocephalus in association with epistaxis: the "twin peaks" sign

Deep brain stimulation and frameless stereotactic radiosurgery in the treatment of bilateral parkinsonian tremor: target selection and case report of two patients