Management of hydrocephalus and subdural hygromas in pediatric patients after decompression of Chiari malformation type I: case series and review of the literature

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  • 1 Department of Neurosurgery, Johns Hopkins All Children’s Institute for Brain Protection Sciences, St. Petersburg;
  • 2 Department of Neurosurgery, University of South Florida, Tampa, Florida; and
  • 3 Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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OBJECTIVE

Hydrocephalus associated with subdural hygromas is a rare complication after decompression of Chiari malformation type I (CM-I). There is no consensus for management of this complication. The authors present a series of 5 pediatric patients who underwent CM-I decompression with placement of a dural graft complicated by posterior fossa hygromas and hydrocephalus that were successfully managed nonoperatively.

METHODS

A retrospective review over the last 5 years of patients who presented with hydrocephalus and subdural hygromas following foramen magnum decompression with placement of a dural graft for CM-I was conducted at 2 pediatric institutions. Their preoperative presentation, perioperative hospital course, and postoperative re-presentation are discussed with attention to their treatment regimen and ultimate outcome. In addition to reporting these cases, the authors discuss all similar cases found in their literature review.

RESULTS

Over the last 5 years, the authors have encountered 194 pediatric cases of CM-I decompression with duraplasty equally distributed at the 2 institutions. Of those cases, 5 pediatric patients with a delayed postoperative complication involving hydrocephalus and subdural hygromas were identified. The 5 patients were managed nonoperatively with acetazolamide and high-dose dexamethasone; dosages of both drugs were adjusted to the age and weight of each patient. All patients were symptom free at follow-up and exhibited resolution of their pathology on imaging. Thirteen similar pediatric cases and 17 adult cases were identified in the literature review. Most reported cases were treated with CSF diversion or reoperation. There were a total of 4 cases previously reported with successful nonoperative management. Of these cases, only 1 case was reported in the pediatric population.

CONCLUSIONS

De novo hydrocephalus, in association with subdural hygromas following CM-I decompression, is rare. This presentation suggests that these complications after posterior fossa decompression with duraplasty can be treated with nonoperative medical management, therefore obviating the need for CSF diversion or reoperation.

ABBREVIATIONS CM-I = Chiari malformation type I; ETV = endoscopic third ventriculostomy; FMD = foramen magnum decompression.

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Contributor Notes

Correspondence Carolyn M. Carey: Johns Hopkins All Children’s Institute for Brain Protection Sciences, St. Petersburg, FL. ccarey12@jhmi.edu.

INCLUDE WHEN CITING Published online July 20, 2018; DOI: 10.3171/2018.4.PEDS17622.

A.C.V. and N.S. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Aitken LA, Lindan CE, Sidney S, Gupta N, Barkovich AJ, Sorel M, : Chiari type I malformation in a pediatric population. Pediatr Neurol 40:449454, 2009

    • Search Google Scholar
    • Export Citation
  • 2

    Alzate JC, Kothbauer KF, Jallo GI, Epstein FJ: Treatment of Chiari I malformation in patients with and without syringomyelia: a consecutive series of 66 cases. Neurosurg Focus 11(1):E3, 2001

    • Search Google Scholar
    • Export Citation
  • 3

    Assina R, Meleis AM, Cohen MA, Iqbal MO, Liu JK: Titanium mesh-assisted dural tenting for an expansile suboccipital cranioplasty in the treatment of Chiari 1 malformation. J Clin Neurosci 21:16411646, 2014

    • Search Google Scholar
    • Export Citation
  • 4

    Bahl A, Murphy M, Thomas N, Gullan R: Management of infratentorial subdural hygroma complicating foramen magnum decompression: a report of three cases. Acta Neurochir (Wien) 153:11231128, 2011

    • Search Google Scholar
    • Export Citation
  • 5

    Bahuleyan B, Menon G, Hariharan E, Sharma M, Nair S: Symptomatic posterior fossa and supratentorial subdural hygromas as a rare complication following foramen magnum decompression for Chiari malformation Type I. J Neurosurg 114:510513, 2011

    • Search Google Scholar
    • Export Citation
  • 6

    Bosma JJD, Kumaran N, May PL: Cerebral oedema following EVD insertion for delayed hydrocephalus after foramen magnum decompression in Chiari I malformation. Childs Nerv Syst 18:474477, 2002

    • Search Google Scholar
    • Export Citation
  • 7

    Duddy MJ, Williams B: Hindbrain migration after decompression for hindbrain hernia: a quantitative assessment using MRI. Br J Neurosurg 5:141152, 1991

    • Search Google Scholar
    • Export Citation
  • 8

    Dyste GN, Menezes AH, VanGilder JC: Symptomatic Chiari malformations. An analysis of presentation, management, and long-term outcome. J Neurosurg 71:159168, 1989

    • Search Google Scholar
    • Export Citation
  • 9

    Elton S, Tubbs RS, Wellons JC III, Blount JP, Grabb PA, Oakes WJ: Acute hydrocephalus following a Chiari I decompression. Pediatr Neurosurg 36:101104, 2002

    • Search Google Scholar
    • Export Citation
  • 10

    Eule JM, Erickson MA, O’Brien MF, Handler M: Chiari I malformation associated with syringomyelia and scoliosis: a twenty-year review of surgical and nonsurgical treatment in a pediatric population. Spine (Phila Pa 1976) 27:14511455, 2002

    • Search Google Scholar
    • Export Citation
  • 11

    Filis AK, Moon K, Cohen AR: Symptomatic subdural hygroma and hydrocephalus following Chiari I decompression. Pediatr Neurosurg 45:425428, 2009

    • Search Google Scholar
    • Export Citation
  • 12

    Furtado SV, Visvanathan K, Reddy K, Hegde AS: Pseudotumor cerebri: as a cause for early deterioration after Chiari I malformation surgery. Childs Nerv Syst 25:10071012, 2009

    • Search Google Scholar
    • Export Citation
  • 13

    Guan J, Riva-Cambrin J, Brockmeyer DL: Chiari-related hydrocephalus: assessment of clinical risk factors in a cohort of 297 consecutive patients. Neurosurg Focus 41(5):E2, 2016

    • Search Google Scholar
    • Export Citation
  • 14

    Hankinson T, Tubbs RS, Wellons JC: Duraplasty or not? An evidence-based review of the pediatric Chiari I malformation. Childs Nerv Syst 27:3540, 2011

    • Search Google Scholar
    • Export Citation
  • 15

    Heller JB, Lazareff J, Gabbay JS, Lam S, Kawamoto HK, Bradley JP: Posterior cranial fossa box expansion leads to resolution of symptomatic cerebellar ptosis following Chiari I malformation repair. J Craniofac Surg 18:274280, 2007

    • Search Google Scholar
    • Export Citation
  • 16

    Holly LT, Batzdorf U: Management of cerebellar ptosis following craniovertebral decompression for Chiari I malformation. J Neurosurg 94:2126, 2001

    • Search Google Scholar
    • Export Citation
  • 17

    Krieger MD, McComb JG, Levy ML: Toward a simpler surgical management of Chiari I malformation in a pediatric population. Pediatr Neurosurg 30:113121, 1999

    • Search Google Scholar
    • Export Citation
  • 18

    Madsen JR, Scott RM: Chiari malformations, syringomyelia, and intramedullary spinal cord tumors. Curr Opin Neurol Neurosurg 6:559563, 1993

    • Search Google Scholar
    • Export Citation
  • 19

    Marshman LA, Benjamin JC, Chawda SJ, David KM: Acute obstructive hydrocephalus associated with infratentorial subdural hygromas complicating Chiari malformation Type I decompression. Report of two cases and literature review. J Neurosurg 103:752755, 2005

    • Search Google Scholar
    • Export Citation
  • 20

    Menezes AH: Chiari I malformations and hydromyelia—complications. Pediatr Neurosurg 17:146154, 19911992

  • 21

    Munakomi S, Bhattarai B, Chaudhary P: Case report: Acute obstructive hydrocephalus associated with infratentorial extra-axial fluid collection following foramen magnum decompression and durotomy for Chiari malformation type I. F1000 Res 5:33, 2016

    • Search Google Scholar
    • Export Citation
  • 22

    Park JK, Gleason PL, Madsen JR, Goumnerova LC, Scott RM: Presentation and management of Chiari I malformation in children. Pediatr Neurosurg 26:190196, 1997

    • Search Google Scholar
    • Export Citation
  • 23

    Pereira EAC, Steele LF, Magdum SA: Recurrent subdural hygromas after foramen magnum decompression for Chiari Type I malformation. Br J Neurosurg 28:396399, 2014

    • Search Google Scholar
    • Export Citation
  • 24

    Perrini P, Rawlinson A, Cowie RA, King AT: Acute external hydrocephalus complicating craniocervical decompression for syringomyelia-Chiari I complex: case report and review of the literature. Neurosurg Rev 31:331335, 2008

    • Search Google Scholar
    • Export Citation
  • 25

    Quigley MF, Iskandar B, Quigley ME, Nicosia M, Haughton V: Cerebrospinal fluid flow in foramen magnum: temporal and spatial patterns at MR imaging in volunteers and in patients with Chiari I malformation. Radiology 232:229236, 2004

    • Search Google Scholar
    • Export Citation
  • 26

    Ranjan A, Cast IP: Symptomatic subdural hygroma as a complication of foramen magnum decompression for hindbrain herniation (Arnold-Chiari deformity). Br J Neurosurg 10:301303, 1996

    • Search Google Scholar
    • Export Citation
  • 27

    Suzuki F, Kitagawa T, Takagi K, Nozaki K: Subacute subdural hygroma and presyrinx formation after foramen magnum decompression with duraplasty for Chiari type 1 malformation. Neurol Med Chir (Tokyo) 51:389393, 2011

    • Search Google Scholar
    • Export Citation
  • 28

    Thakar S, Dadlani R, Tawari M, Hegde AS: Atypical cerebellar slump syndrome and external hydrocephalus following craniocervical decompression for Chiari I malformation: case report. Neurol Med Chir (Tokyo) 54:567571, 2014

    • Search Google Scholar
    • Export Citation
  • 29

    Tubbs RS, Beckman J, Naftel RP, Chern JJ, Wellons JC III, Rozzelle CJ, : Institutional experience with 500 cases of surgically treated pediatric Chiari malformation Type I. J Neurosurg Pediatr 7:248256, 2011

    • Search Google Scholar
    • Export Citation
  • 30

    Tubbs RS, Lyerly MJ, Loukas M, Shoja MM, Oakes WJ: The pediatric Chiari I malformation: a review. Childs Nerv Syst 23:12391250, 2007

  • 31

    Zakaria R, Kandasamy J, Khan Y, Jenkinson MD, Hall SR, Brodbelt A, : Raised intracranial pressure and hydrocephalus following hindbrain decompression for Chiari I malformation: a case series and review of the literature. Br J Neurosurg 26:476481, 2012

    • Search Google Scholar
    • Export Citation

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