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Child's Nervous System

, Volume 35, Issue 10, pp 1711–1717 | Cite as

Chiari I malformation and altered cerebrospinal fluid dynamics—the highs and the lows

  • Soumya Mukherjee
  • Neeraj Kalra
  • Daniel Warren
  • Gnanamurthy Sivakumar
  • John R. Goodden
  • Atul K. Tyagi
  • Paul D. Chumas
Special Annual Issue

Abstract

Purpose

This paper reviews the altered cerebrospinal fluid dynamics that can be associated with paediatric Chiari I malformation and we present our own institutional experience.

Methods

We conducted a thorough review of the literature and retrospectively analyzed all cases of operatively managed paediatric Chiari 1 malformation at our institution between February 2006 and February 2019.

Results

Acquired Chiari malformation (ACM) can radiologically mimic Chiari I and has been associated with both intracranial hypotension (either secondary to lumboperitoneal shunting or spontaneous CSF hypotension) and idiopathic intracranial hypertension (IIH). At our institution, 61 paediatric cases (range, 2–15 years) underwent foramen magnum decompression (FMD) for Chiari I malformation. Whilst 80% (50/61) of cases underwent FMD with no preceding or post-operative problems of CSF dynamics, 8% (5/61) of cases had hydrocephalus at initial presentation requiring CSF diversion followed by FMD for persistent Chiari, and 10% (6/61) developed hydrocephalus following FMD and required long-term CSF diversion.

Conclusions

In paediatric ACM, the management of intracranial hypotension involves thorough radiological assessment and inclusion/adjustment of a valve in the case of lumboperitoneal shunting or epidural blood patch or interventional techniques in the case of spontaneous CSF leak. Thereby, unwarranted posterior fossa decompression surgery is avoided. In the case of IIH and Chiari I malformation, children who have recurrent symptoms despite adequate posterior fossa decompression surgery (failed Chiari), there is a strong role for intracranial pressure monitoring as raised intracranial pressure may indicate long-term CSF diversion.

Keywords

Chiari malformation Intracranial hypotension Lumboperitoneal shunt Cerebrospinal fluid leak Intracranial hypertension Paediatrics 

Notes

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Soumya Mukherjee
    • 1
  • Neeraj Kalra
    • 1
  • Daniel Warren
    • 2
  • Gnanamurthy Sivakumar
    • 1
  • John R. Goodden
    • 1
  • Atul K. Tyagi
    • 1
  • Paul D. Chumas
    • 1
  1. 1.Department of Paediatric NeurosurgeryLeeds General InfirmaryLeedsUK
  2. 2.Department of Paediatric NeuroradiologyLeeds General InfirmaryLeedsUK

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