Ossified pseudomeningocele following Chiari decompression surgery in a patient with Kleeblattschädel deformity

Case report

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The authors present the case of a 3-year-old child with Kleeblattschädel, or cloverleaf skull deformity, and a Chiari malformation Type I who developed an ossified pseudomeningocele after posterior fossa decompression. To their knowledge, this is the first report of a postoperative ossified pseudomeningocele in a patient with Kleeblattschädel and the only case of an ossified pseudomeningocele located outside the lumbosacral region. A genetic basis for the ossification process seems likely given the child's history of premature cranial suture closure. The authors draw attention to this rare complication and review the available body of literature on this topic.

Abbreviations used in this paper: CM-I = Chiari malformation Type 1; CSF = cerebrospinal fluid.

Article Information

Address correspondence to: Matthew R. Reynolds, M.D., Ph.D., Barnes-Jewish Hospital, Department of Neurosurgery, 660 South Euclid Avenue, Campus Box 8057, St. Louis, Missouri 63110. email: reynoldsm@wudosis.wustl.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Three-dimensional CT reconstructions demonstrating anteroposterior (A), lateral (B), and posteroanterior (C) views of the child's initial Kleeblattschädel skull deformity.

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    Preoperative parasagittal MR images. Left: A T1-weighted MR image showing the CM-1. Right: A T2-weighted MR image demonstrating cervical cord compression, edema, and a developing syrinx.

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    Postoperative parasagittal MR images. A T1-weighted image (left) and a T2-weighted image (right) demonstrating a suboccipital pseudomeningocele as well as decreased cervical spinal cord edema.

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    Axial bone window CT scans. A and B: Scans of the head demonstrating posterior calcification of the pseudomeningocele. Panel A shows the superior aspect of the posterior fossa decompression with the developing calcification. C: Scan obtained at the level of the C-1 laminectomy showing absence of reossification at the laminectomy site.

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