Abstract
A 39-year old man came to our outpatient clinic with long history of unspecific symptoms and signs. Cerebral MRI showed herniation of the cerebellar tonsils of more than 1 cm below the foramen magnum and a triventricular hydrocephalus. A diagnosis of Chiari I malformation was retained. After an osteo-dural decompression of the posterior fossa, post-operative MRI revealed an aqueductal stenosis with triventricular hydrocephalus. An endoscopic-third- ventriculostomy showed an idiopathic stenosis of the right foramen of Monro. Residual symptoms and persistence of biventricular hydrocephalus justified a ventriculo-peritoneal shunt. Aqueductal and foramina of Monro stenosis can mimick a Chiari I malformation.
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Comment
In this paper, the authors report an intriguing case of a Chiari malformation type I associated with a stenosis of bilateral foramina Monroi, which was misdiagnosed before surgery. The authors suppose that a high pressure gradient between the lateral ventricles and the third ventricle is the cause of the deformity of the third ventricle. In fact, to my knowledge, no enquiries have been published on the pressure gradient inside the ventricular system in obstructive hydrocephalus. The case is attractive and may support our observations of other cases of Chiari malformation with postoperative CSF flow dysregulation. This can be reasonably explained by a hidden obstructive hydrocephalus and confirms the hypothesis, that the Chiari malformation should be assimilated to a CSF flow impairment. Research studies should be performed in order to gain more insight into the pathophysiology of these pathologies.
Alex Alfieri
Sebastian Simmermacher
Gershom Koman
Halle (Saale), Germany
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Bartoli, A., Ghinda, C.D., Radovanovic, I. et al. Hidden aqueductal stenosis associated to bilateral idiopathic foramina of Monro stenosis mimicking a Chiari I malformation? Case report. Acta Neurochir 154, 2109–2113 (2012). https://doi.org/10.1007/s00701-012-1438-6
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DOI: https://doi.org/10.1007/s00701-012-1438-6