Hajtovic Sabastian, Placantonakis Dimitris G
Neurosurgery, City University of New York (CUNY) School of Medicine, Sophie Davis Biomedical Education Program, New York, USA.
Neurosurgery, New York University (NYU) School of Medicine, New York, USA.
Cureus. 2020 Apr 11;12(4):e7636. doi: 10.7759/cureus.7636.
Chiari I malformation is the herniation of cerebellar tonsils below the level of the foramen magnum due to congenital or acquired pathologies. Acquired Chiari I malformation (ACM) may occur secondary to space-occupying lesions (SOLs), such as intracranial tumors due to elevated intracranial pressure (ICP), and can be accompanied by syringomyelia. ACM and syringomyelia have been shown to resolve after resection of the SOL, without the need for adjuvant posterior fossa decompression. The vast majority of SOLs leading to ACM have been reported in the posterior fossa, thus exerting a direct mass effect on the cerebellum. Supratentorial SOLs leading to ACM are much less frequent but, when present, are most commonly parieto-occipital. We report a rare case of a large anterior left frontal, parasagittal meningioma causing ACM and syringomyelia. These findings resolved following the resection of the meningioma, with no further surgical intervention. Our case demonstrates that ACM can occur secondary to an anterior supratentorial mass and further supports the idea that decompression of the posterior fossa is not required for the resolution of intracranial tumor-associated ACM and syringomyelia.
Chiari I畸形是指由于先天性或后天性病变导致小脑扁桃体疝入枕骨大孔水平以下。后天性Chiari I畸形（ACM）可能继发于占位性病变（SOLs），如由于颅内压（ICP）升高引起的颅内肿瘤，并可能伴有脊髓空洞症。已证明在切除SOL后，ACM和脊髓空洞症可得到缓解，无需辅助后颅窝减压。据报道，导致ACM的绝大多数SOL位于后颅窝，因此对小脑产生直接的占位效应。导致ACM的幕上SOL则要少见得多，但一旦出现，最常见于顶枕部。我们报告了一例罕见的病例，一名左侧额前巨大矢旁脑膜瘤导致ACM和脊髓空洞症。切除脑膜瘤后这些症状得到缓解，无需进一步手术干预。我们的病例表明，ACM可继发于幕上前部肿块，并进一步支持了这样一种观点，即对于颅内肿瘤相关的ACM和脊髓空洞症的缓解，无需进行后颅窝减压。
