Chiari I malformation:: a rare cause of noncommunicating hydrocephalus treated by third ventriculostomy

被引:58
作者
Decq, P [1 ]
Le Guérinel, C [1 ]
Sol, JC [1 ]
Brugières, P [1 ]
Djindjian, M [1 ]
Nguyen, JP [1 ]
机构
[1] Hop Henri Mondor, Serv Neurochirurg & Neuroradiol, Creteil, France
关键词
hydrocephalus; syringomyelia; Chiari malformation; ventriculostomy; endoscopy;
D O I
10.3171/jns.2001.95.5.0783
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Object. Hydrocephalus associated with Chiari I malformation is a rare entity related to an obstruction in the flow of cerebrospinal fluid (CSF) in the foramen of Magendie. Like all forms of noncommunicating hydrocephalus, it can be treated by endoscopic third ventriculostomy (ETV). The object of this study is to report a series of five cases of hydrocephalus associated with Chiari I malformation and to evaluate the use of ETV in the treatment of this anomaly. Methods, Five patients (four women and one man with a mean age of 29.6 years) underwent ETV for hydrocephalus associated with Chiari I malformation between April 1991 and February 1997. All patients had presented with paroxysmal headaches, which in two cases were associated with visual disorders. All patients had also presented with hydrocephalus (mean transverse diameter of the third ventricle 12.79 mm; mean sagittal diameter of the fourth ventricle 18.27 mm) with a mean herniation of the cerebellar tonsils at 13.75 min below the basion-opisthion line. Surgery was performed in all patients by using a rigid endoscope. No complications occurred either during or after the procedure, except in one patient who experienced a wound infection that was treated by antibiotic medications. The mean duration of follow up in this study was 50.39 months. Four patients became completely asymptomatic and remained stable throughout the follow-up period. One patient required an additional third ventriculostomy after 1 year, due to secondary closure, and has remained stable since that time. Postoperative magnetic resonance images demonstrated a significant reduction in the extent of hydrocephalus in all patients (mean transverse diameter of the third ventricle 6.9 nun [p = 0.0035]; mean sagittal diameter of the fourth ventricle 10.32 nun [p = 0.007]), with a mean ascent of the cerebellar tonsils from 13.75 nun below the basion-opisthion line to 7.76 nun below it (p = 0.01). In addition, CSF flow was identified on either side of the orifice of the third ventriculostomy in all patients postoperatively. Conclusions. Results in this series confirm the efficacy of ETV in the treatment of hydrocephalus associated with Chiari I malformation. It is a reliable, minimally invasive technique that also provides a better understanding of the pathophysiology of this malformation.
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收藏
页码:783 / 790
页数:8
相关论文
共 58 条
[41]   MORPHOGENESIS OF EXPERIMENTALLY INDUCED ARNOLD-CHIARI MALFORMATION [J].
MARINPADILLA, M ;
MARINPADILLA, TM .
JOURNAL OF THE NEUROLOGICAL SCIENCES, 1981, 50 (01) :29-55
[42]   Chiari I malformation redefined: Clinical and radiographic findings for 364 symptomatic patients [J].
Milhorat, TH ;
Chou, MW ;
Trinidad, EM ;
Kula, RW ;
Mandell, M ;
Wolpert, C ;
Speer, MC .
NEUROSURGERY, 1999, 44 (05) :1005-1017
[43]   Neuroendoscopic third ventriculostomy in the management of fourth ventricular outlet obstruction [J].
Mohanty, A ;
Anandh, B ;
Kolluri, VRS ;
Praharaj, SS .
MINIMALLY INVASIVE NEUROSURGERY, 1999, 42 (01) :18-21
[44]   Pathogenesis of Chiari malformation: A morphometric study of the posterior cranial fossa [J].
Nishikawa, M ;
Sakamoto, H ;
Hakuba, A ;
Nakanishi, N ;
Inoue, Y .
JOURNAL OF NEUROSURGERY, 1997, 86 (01) :40-47
[45]   SIZE OF POSTERIOR-FOSSA IN CHIARI TYPE-1 MALFORMATION IN ADULTS [J].
NYLAND, H ;
KROGNESS, KG .
ACTA NEUROCHIRURGICA, 1978, 40 (3-4) :233-242
[46]   PATHOPHYSIOLOGY OF SYRINGOMYELIA ASSOCIATED WITH CHIARI I MALFORMATION OF THE CEREBELLAR TONSILS - IMPLICATIONS FOR DIAGNOSIS AND TREATMENT [J].
OLDFIELD, EH ;
MURASZKO, K ;
SHAWKER, TH ;
PATRONAS, NJ .
JOURNAL OF NEUROSURGERY, 1994, 80 (01) :3-15
[47]   HEADACHE IN TYPE-I CHIARI MALFORMATION [J].
PASCUAL, J ;
OTERINO, A ;
BERCIANO, J .
NEUROLOGY, 1992, 42 (08) :1519-1521
[48]   SYMPTOMATIC CHIARI MALFORMATION IN ADULTS - A NEW CLASSIFICATION BASED ON MAGNETIC-RESONANCE-IMAGING WITH CLINICAL AND PROGNOSTIC-SIGNIFICANCE [J].
PILLAY, PK ;
AWAD, IA ;
LITTLE, JR ;
HAHN, JF .
NEUROSURGERY, 1991, 28 (05) :639-645
[49]   CONGENITAL 4TH VENTRICULAR MIDLINE OUTLET OBSTRUCTION - REPORT OF 2 CASES [J].
RIFKINSONMANN, S ;
SACHDEV, VP ;
HUANG, YP .
JOURNAL OF NEUROSURGERY, 1987, 67 (04) :595-599
[50]  
Sainte-Rose C, 1992, NEUROENDOSCOPY, P47