Hydrogel-induced cervicomedullary compression after posterior fossa decompression for Chiari malformation

Case report

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✓The use of an absorbable hydrogel dural sealant has been approved for neurosurgical applications with no published reports of complications to date. The authors present the case of a 13-year-old girl with syringomyelia and quadriparesis who underwent posterior fossa decompression and dural augmentation for Chiari malformation Type I. Dural closure was performed with a dural substitute patch, hydrogel dural sealant, and gelatin sponge. Magnetic resonance imaging, performed after initial postoperative improvement in the patient's quadriparesis deteriorated, demonstrated an expanding epidural mass collection causing cervicomedullary compression. Exploration on postoperative Day 15 revealed an expanded layer of hydrogel underlying a layer of gelatin sponge. The authors conclude that hydrogel dural sealants should be used cautiously in spaces that cannot tolerate significant mass effect.

Abbreviations used in this paper:CM-I = Chiari malformation Type I; CSF = cerebrospinal fluid; CT = computed tomography; FLAIR = fluid attenuated inversion recovery; MR = magnetic resonance.

Article Information

Address reprint requests to: Spiros Lee Blackburn, M.D., Barnes-Jewish Hospital, Department of Neurosurgery, 660 South Euclid Street, Campus Box 8057, St. Louis, Missouri 63110. email: blackburns@nsurg.wustl.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Preoperative T1-weighted (left) and T2-weighted (right) sagittal MR images demonstrating CM-I.

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    Postoperative T1-weighted contrast-enhanced (left) and T2-weighted (right) MR images obtained 2 days after the initial surgery showing decompression of the CM-I and a small epidural collection of intensity similar to that of CSF.

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    Neuroimages obtained on postoperative Day 15 revealing expansion of the epidural collection. A sagittal T1-weighted contrast-enhanced MR image (A) shows a large homogeneous, hypointense collection, which appears similar to CSF on T2-weighted imaging (B). An axial FLAIR image (C) reveals the hydrogel posterior to the upper cervical cord.

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    Sagittal T1-weighted (left) and T2-weighted (right) MR images obtained at the 6-month follow up demonstrating CSF between the cerebellum and spinal cord. Interval improvement in the patient's preoperative syrinx is visible on the T2-weighted image.

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