Presentation
Chronic headaches for decades, increasing over the past 1-2 years. Headaches are occipital, worse with sneezing, coughing, stretching, or with cold temperatures. Tingling in the fingers since last year, intermittently. No fine motor dysfunction. No drop attacks.30
Patient Data
The cerebellar tonsils are low-lying, reaching the posterior arch of C1 with little, if any, CSF around the cervicomedullary junction.
No hydrocephalus. Limited CSF flow on flow studies. No syrinx in the upper parts of the cervical cord.
Posterior fossa decompression with duroplasty, resulting in a widely patent foramen magnum and significant improvement in tonsillar descent, with both tonsils above the level of the upper C1 posterior arch. CSF flow studies demonstrate flow through the foramen magnum. Normal ventricular size.
A tiny right cerebellar meningoencephalocele is noted. Small pineal cysts are noted.
Conclusion:
Significant improvement in tonsilar descent and widely patent foramen magnum after posterior fossa decompression.
Case Discussion
Not only did decompression substantially improve the imaging appearances of this patient with a Chiari 1 malformation but, more importantly, it resulted in significant symptomatic improvement with reduction of headaches.
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