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Vertebrobasilar Insufficiency Due to Distal Posterior Inferior Cerebellar Artery Compression in Chiari 1.5.

TitleVertebrobasilar Insufficiency Due to Distal Posterior Inferior Cerebellar Artery Compression in Chiari 1.5.
Publication TypeJournal Article
Year of Publication2017
AuthorsM Janjua B, Ivasyk I, Greenfield JP
JournalWorld Neurosurg
Volume104
Pagination1050.e1-1050.e6
Date Published2017 Aug
ISSN1878-8769
KeywordsAdult, Arnold-Chiari Malformation, Cerebellum, Cerebral Angiography, Decompression, Surgical, Encephalocele, Female, Humans, Magnetic Resonance Angiography, Medulla Oblongata, Neurosurgical Procedures, Syringomyelia, Vertebrobasilar Insufficiency
Abstract

BACKGROUND: Chiari malformation is characterized by radiographic evidence of herniation of cerebellar tonsils below the foramen magnum and a symptom complex of headaches; breathing, swallowing, or sleep difficulties; ataxia; restless; and motor and/or sensory deficits.

CASE DESCRIPTION: We report a case of a 34-year-old woman whose imaging indicated a Chiari 1.5 with brainstem (caudal medulla) herniation and an expansive cervical syrinx. Her symptom complex showed signs both of cervical syringomyelia, as well as ones localizable to the medulla. An intradural exploration revealed the occlusion and caudal displacement of the loop of the right posterior inferior cerebellar artery, which was later confirmed via magnetic resonance angiography.

CONCLUSIONS: In the setting of severe Chiari malformations, particularly the Chiari 1.5 variant, assessment of the posterior fossa vasculature may be useful in defining a subset of patients with preoperative compromise in posterior fossa blood flow and postoperative expectations. Preoperative planning and exploration of midline dorsal brain stem along with the tonsilomedullary fissure could be helpful for contribution of vascular pathology among Chiari symptoms complex in these patients.

DOI10.1016/j.wneu.2017.05.089
Alternate JournalWorld Neurosurg
PubMed ID28583457