Intracranial hypertension following sacrifice of occipital and marginal sinuses during posterior fossa decompression for Chiari I malformation: case report

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The occipital and marginal sinuses, when present, must be sacrificed in order to open the dura in most posterior fossa surgeries in the pediatric population, including posterior fossa decompression for Type I Chiari malformation (CM-I) with duraplasty. Apart from the immediate risk of hemorrhage, the voluntary occlusion of this structure is almost universally well tolerated. The authors report a case of intracranial hypertension following the sacrifice of occipital and marginal sinuses following posterior fossa decompression with duraplasty for CM-I. The specific draining pattern variant of the occipital and marginal sinuses leading to this complication as well as avoidance and management strategies of this condition are discussed.

ABBREVIATIONS CM-I = Type I Chiari malformation.

Article Information

Correspondence Alexander G. Weil: Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada. alexandergweil@gmail.com.

INCLUDE WHEN CITING Published online September 21, 2018; DOI: 10.3171/2018.7.PEDS18237.

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

© AANS, except where prohibited by US copyright law.

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Figures

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    Preoperative T2-weighted MRI. A: Sagittal image of the head showing CM-I and the superior extension of the hydromyelia. B: Sagittal image of the thoracic spine showing hydromyelia spanning the entire thoracic cord. C: Sagittal image of the lumbar spine showing hydromyelia reaching the conus medullaris.

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    Postoperative T2-weighted MRI. A: Sagittal image showing adequate decompression of the craniocervical junction. B and C: Axial images showing ventricles of normal size.

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    Postoperative MR images showing absence of occipital and marginal sinuses and slightly hypoplastic transverse sinuses. A, B, and D: Gd-enhanced T1-weighted axial (A), coronal (B), and sagittal (D) images. C: 3D reconstruction of venous drainage from an MR angiography (MRA)–MR venography (MRV).

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    Preoperative Gd-enhanced T1-weighted sagittal (A and C), axial (B), and coronal (D) MR images showing very prominent occipital sinus and marginal sinuses, which drained directly into the sigmoid sinus and jugular vein bilaterally (arrows). Figure is available in color online only.

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