Chiari I malformation and acute acquired comitant esotropia

Case report and review of the literature

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  • 1 Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center; and Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
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✓The authors describe a rare case of a Chiari I malformation presenting with acute acquired comitant esotropia (AACE) in a 5-year-old boy. A posterior fossa decompression with duraplasty and a C1–2 laminectomy were performed. There was an immediate postoperative improvement in the esotropia, which completely resolved by 7 months following surgery. The pertinent literature is discussed and reasons are presented for recommending posterior fossa decompression in certain patients, rather than strabismus surgery, as the initial treatment for esotropia. The authors suggest that in patients with AACE, even subtle symptoms and signs of Chiari I malformation should prompt imaging of the posterior fossa. Strong consideration should be given to performing posterior fossa decompression in patients with Chiari I malformation and AACE before strabismus surgery because the esotropia may completely resolve with decompression.

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Contributor Notes

Address reprint requests to: Frederick F. Lang, M.D., Department of Neurosurgery, M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 442, Houston, Texas 77030-4009. email: flang@mdanderson.org.
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