Hydrocephalus after foramen magnum decompression for Chiari I malformation successfully treated with the aspiration of pseudomeningocele: a case report

BACKGROUND: Pseudomeningocele or cerebrospinal fluid leakage is one of the most common complications of foramen magnum decompression with duraplasty for Chiari I malformation. Usually, cerebrospinal fluid leakage is treated with lumbar drainage and/or secondary suture. However, if hydrocephalus occurs, spinal drainage may cause brain herniation. CASE PRESENTATION: A 54-year-old Japanese woman presented to our hospital with a 10-month history of bilateral finger extension weakness and clumsiness. Magnetic resonance imaging showed displacement of her cerebellar tonsils below the foramen magnum level, with syringomyelia presenting from the C4 to T8 level. Suboccipital craniectomy and C1 laminectomy with duraplasty were performed under general anesthesia. At 1 month after discharge, she again presented to our hospital due to severe headache and nausea. Magnetic resonance imaging of her cervical spine showed pseudomeningocele compressing her cerebellum and spinal cord. Magnetic resonance imaging of her brain also showed ventriculomegaly. Pseudomeningocele aspiration was performed, with 25 ml of fluid removed under X-ray control. Immediately after aspiration her headache and nausea decreased, and she reported improvement in her symptoms with increasing bilateral finger extension strength and decreasing bilateral upper extremity numbness at her 1-year follow-up. CONCLUSIONS: Although there is a considerable risk of meningitis with the aspiration procedure of pseudomeningocele, an aspiration procedure may be an easy and effective treatment option for postoperative hydrocephalus after suboccipital craniotomy with duraplasty in a patient treated for Chiari I malformation.