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Synchronous complex Chiari malformation and cleft palate-a case-based review.

TitleSynchronous complex Chiari malformation and cleft palate-a case-based review.
Publication TypeJournal Article
Year of Publication2018
AuthorsLara-Reyna J, Carlton J, Parker WE, Greenfield JP
JournalChilds Nerv Syst
Volume34
Issue12
Pagination2353-2359
Date Published2018 12
ISSN1433-0350
KeywordsAbnormalities, Multiple, Adolescent, Arnold-Chiari Malformation, Cleft Palate, Humans, Infant, Male
Abstract

BACKGROUND: The association between mid-facial clefts and Chiari malformation in the medical literature has been restricted to patients with syndromic craniofacial abnormalities. A common shared developmental pathway including causative factors for facial clefts and "complex" Chiari malformations, both midline skull base pathologies, seems logical but has not been reported. The coincident presentation of these findings in a single patient, and our subsequent discovery of other patients harboring these mutual findings prompted further investigation.

CASE ILLUSTRATION: We describe the case of a patient born with a cleft palate which was repaired during his first year of life, subsequently presenting as a teenager to our hospital with a severe and symptomatic complex Chiari malformation. We discuss his treatment strategy, suboccipital decompression with occipitocervical fusion and endoscopic anterior decompression surgeries, as well as his favorable radiological and clinical outcome, demonstrated at long-interval follow-up. Furthermore, we review his two pathologies, cleft palate and Chiari malformation, and posit a common embryological linkage.

CONCLUSIONS: The embryologic interaction between the paraxial mesoderm and ectoderm may explain the co-occurrence of cleft palate and complex Chiari malformation in a single patient. Complete radiological, clinical, and genetic evaluation and counseling is advised in this situation and raises the question of whether the presence of a cleft palate independently increases the risk for other skull base developmental abnormalities.

DOI10.1007/s00381-018-3950-3
Alternate JournalChilds Nerv Syst
PubMed ID30128838