Sakaki T, Tsunoda S, Morimoto T, Utsumi S
Department of Neurosurgery, Nara Medical University.
Neurol Med Chir (Tokyo). 1990 May;30(5):324-8. doi: 10.2176/nmc.30.324.
Three cases in which the signs and symptoms of Chiari I malformation were induced and worsened after the occurrence of supratentorial mass lesions are reported. The symptoms improved markedly after removal of the supratentorial lesions in these cases. In the first case, a meningioma in the right parietal region coexisted with Chiari I malformation. Although the cerebellar ataxia and nystagmus disappeared after tumor removal, decompressive surgery for the malformation was performed because of upper cervical nerve symptoms and the patient recovered completely. In the second case, the symptoms first occurred after a car accident, and a computed tomographic scan revealed not only a subdural hematoma, but also tonsillar herniation due to Chiari I malformation. After evacuation of the hematoma and decompressive surgery on the craniospinal junction, the symptoms disappeared. In the third case, the symptoms of malformation developed gradually with depression and gait disturbance. A meningioma in the left frontal region coexisted with Chiari I malformation. Although the symptoms improved remarkably after tumor removal, decompressive surgery on the craniospinal junction was performed because of upper cervical nerve symptoms, and the patient recovered completely. These clinical findings indicate that a supratentorial mass lesion may provoke the symptoms of Chiari I malformation in the aged.
报告了3例幕上占位性病变发生后Chiari I畸形的体征和症状被诱发并加重的病例。这些病例在切除幕上病变后症状明显改善。第一例中，右侧顶叶脑膜瘤与Chiari I畸形并存。虽然肿瘤切除后小脑共济失调和眼球震颤消失，但由于上颈神经症状进行了畸形减压手术，患者完全康复。第二例中，症状首次出现在车祸后，计算机断层扫描显示不仅有硬膜下血肿，还有因Chiari I畸形导致的扁桃体疝。血肿清除和颅颈交界区减压手术后，症状消失。第三例中，畸形症状随着抑郁和步态障碍逐渐发展。左侧额叶脑膜瘤与Chiari I畸形并存。虽然肿瘤切除后症状明显改善，但由于上颈神经症状进行了颅颈交界区减压手术，患者完全康复。这些临床发现表明，幕上占位性病变可能诱发老年人Chiari I畸形的症状。
