Frank Dewaele1, Alain F Kalmar2, Edward Baert1, Annemieke Van Haver3, Giorgio Hallaert1, Frank De Mets4, Leonie Williams5, Jean Pierre Kalala Okito1, Koen Paemeleire6, Jacques Caemaert1, Dirk Van Roost1. 1. a Department of Neurosurgery , Ghent University Hospital , Ghent , Belgium. 2. b Department of Anesthesiology and Intensive Care Medicine , Maria Middelares Hospital , Ghent , Belgium and Department of Anesthesiology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands. 3. c Department of Mechanics , University College Ghent , Belgium. 4. d Department of Industrial Technology and Construction , University Ghent , Belgium. 5. e Department of Psychiatry , Wotton Lawn Hospital , Gloucester, Gloucestershire , UK. 6. f Department of Neurology , Ghent University Hospital , Ghent , Belgium.
Abstract
BACKGROUND: State-of-the-art treatment for Chiari Malformation I (CM-I) consists of decompression by posterior fossa craniectomy. A rare but severe complication that develops over months to years after this procedure is cerebellar slump. Treatment options for this condition are limited. We present a new and promising approach to treat this rare condition. METHODS: The patients were placed in the Trendelenburg position to facilitate ascent of the cerebellum. After almost complete dissolution of neurologic symptoms, surgical reconstruction was performed by tonsillar resection and the creation of a new structural support using a bone graft. RESULTS: Both patients experienced good clinical and morphological outcomes immediately after surgery, and for two years thereafter. CONCLUSIONS: Neurological symptoms related to cerebellar or brainstem slump can be adequately reversed by placing the patient in the Trendelenburg position. After uneventful gravitational reversal of the slump, safe surgical reconstruction of the cerebellar support can be performed to securely preserve the anatomical reversal.
BACKGROUND: State-of-the-art treatment for Chiari Malformation I (CM-I) consists of decompression by posterior fossa craniectomy. A rare but severe complication that develops over months to years after this procedure is cerebellar slump. Treatment options for this condition are limited. We present a new and promising approach to treat this rare condition. METHODS: The patients were placed in the Trendelenburg position to facilitate ascent of the cerebellum. After almost complete dissolution of neurologic symptoms, surgical reconstruction was performed by tonsillar resection and the creation of a new structural support using a bone graft. RESULTS: Both patients experienced good clinical and morphological outcomes immediately after surgery, and for two years thereafter. CONCLUSIONS: Neurological symptoms related to cerebellar or brainstem slump can be adequately reversed by placing the patient in the Trendelenburg position. After uneventful gravitational reversal of the slump, safe surgical reconstruction of the cerebellar support can be performed to securely preserve the anatomical reversal.