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Neurological outcome following delayed traction and fixation in severe tetraparesis consecutive to posterior decompression for Chiari malformation: a case report

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Abstract

Background

Chiari malformation type 1 (CM1) is a congenital hindbrain malformation characterized by herniation of the cerebellar tonsils below the foramen magnum. The term Chiari type 1.5 is used when herniation of the brainstem under the McRae line and anomalies of the craniovertebral junction are also present. These conditions are associated with several symptoms and signs, including headache, neck pain, and spinal cord syndrome. For symptomatic patients, surgical decompression is recommended. When radiographic indicators of craniovertebral junction (CVJ) instability or symptoms related to ventral brainstem compression are present, CVJ fixation should also be considered.

Case description

We report the case of a 13-year-old girl who presented with severe tetraparesis after posterior decompression for Chiari malformation type 1.5, followed 5 days later by partial C2 laminectomy. Several months after the initial surgery, she underwent two fixations, first without and then with intraoperative cervical traction, leading to significant neurological improvement.

Discussion and conclusion

This case report underscores the importance of meticulous radiological analysis before CM surgery. For CM 1.5 patients with basilar invagination, CVJ fixation is recommended, and C2 laminectomy should be avoided. In the event of significant clinical deterioration due to nonadherence to these guidelines, our findings highlight the importance of traction with increased extension before fixation, even years after initial destabilizing surgery.

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Data availability

No datasets were generated or analyzed during the current study.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of Neurosurgery, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

    Eric Vigneul, Nicole Del Gaudio & Loïc de Nijs

  2. Laboratory of Neural Differentiation (NEDI), Animal Molecular and Cellular Biology Group, Louvain Institute of Biomolecular Science and Technology, Université Catholique de Louvain, Louvain-La-Neuve, Belgium

    Eric Vigneul

  3. Neurosurgery, Delta Hospital CHIREC, Brussels, Belgium

    Christian Raftopoulos

Authors
  1. Eric Vigneul
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  2. Nicole Del Gaudio
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  3. Loïc de Nijs
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  4. Christian Raftopoulos
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Contributions

EV wrote the paper, reviewed the litterature and followed the patient; NdG and LdN reviewed the paper, followed the patient and assisted the senior surgeon during the surgery; CR defined the strategy, operated on the patient and reviewed the paper.

Corresponding author

Correspondence to Christian Raftopoulos.

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The authors declare no competing interests.

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The patient and her family consented to the submission of the case report to the journal.

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No financial support was received for this work. The patient and her family consented to the submission of the case report to the journal. Consent to participate: The patient and her family consented to the submission of the case report to the journal.

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The patient and her family have consented to the submission of the case report to the journal.

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The manuscript is an original contribution that has not been submitted simultaneously to another journal or published elsewhere, partially or in full in any form or language. The results are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation (including image-based manipulation).

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Vigneul, E., Del Gaudio, N., de Nijs, L. et al. Neurological outcome following delayed traction and fixation in severe tetraparesis consecutive to posterior decompression for Chiari malformation: a case report. Childs Nerv Syst (2024). https://doi.org/10.1007/s00381-024-06327-6

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