engleski

Myelopathy resolution after Chiari I malformation (CIM) decompression: Video clip case report and microsurgical technique

Chiari I malformation (CIM) is a well-known condition affecting 1%of the population [1–4]. Patients are evaluated with magnetic re- sonance imaging (MRI) ; sagittal T2-weighted MRI of the cervical andthoracic spine is helpful for diagnosis. Flexion and extension dynamicX-rays of the cervical spine can rule-out craniocervical and spinal in-stability. Typical presenting symptoms include severe suboccipitalheadaches worsening with Valsalva maneuvers, myelopathy, andbrainstem- related symptoms. Postoperatively, neurological symptomsand myelopathy were reported to improved/resolved in 73% of adultand 84% of pediatric patients ; headaches were reported to improved/resolved in 73% of adult and 88% of pediatric patients [2]. Although acommon operation, a video case report of microsurgical decompressionof CIM has not been previously published in the literature.This video depicts the surgical case of 32 y/o male with CIM pre-senting with severe myelopathy and gait difficulties. We performeddecompressive suboccipital craniotomy and C1 laminectomy, followedby microsurgical decompression of the craniocervical junction sub- arachnoid spaces. We opened the Foramen of Magendie, and the leftand right cerebello- medullary cisterns, re-establishing the cerebrospinalcirculation across the craniospinal subarachnoid spaces. Closure wasperformed with bovine pericardium allograft that enlarged the duralsac. Fibrin glue and fat tissue autograft (with fat harvested from thepatient's periumbilical area at surgery start) was used for closure and toprevent cerebrospinalfluid leak and pseudomeningocele formation.We followed the patient after 3 weeks and 3 months post- operatively—his myelopathy completely resolved. Further follow upcontinued every 6 months.Written consent was obtained directly from the patient.

Chiari I malformation ; Microsurgery ; Decompression ; Suboccipital craniotomy ; C1 laminectomy ; Cerebellomedullary cisterns

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