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Secondary Chiari malformation due to enlarged spinal arachnoid villi–like structure: illustrative case

BACKGROUND: Secondary Chiari malformation can be caused by various disorders associated with cerebrospinal fluid (CSF) leakage at the spinal level. In this report, the authors describe a rare case of secondary Chiari malformation caused by excessive CSF absorption through the enlarged spinal arachno...

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Autores principales: Koyanagi, Izumi, Chiba, Yasuhiro, Imamura, Hiroyuki, Yoshino, Masami, Aida, Toshimitsu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Association of Neurological Surgeons 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9241318/
https://www.ncbi.nlm.nih.gov/pubmed/35854931
http://dx.doi.org/10.3171/CASE2049
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author Koyanagi, Izumi
Chiba, Yasuhiro
Imamura, Hiroyuki
Yoshino, Masami
Aida, Toshimitsu
author_facet Koyanagi, Izumi
Chiba, Yasuhiro
Imamura, Hiroyuki
Yoshino, Masami
Aida, Toshimitsu
author_sort Koyanagi, Izumi
collection PubMed
description BACKGROUND: Secondary Chiari malformation can be caused by various disorders associated with cerebrospinal fluid (CSF) leakage at the spinal level. In this report, the authors describe a rare case of secondary Chiari malformation caused by excessive CSF absorption through the enlarged spinal arachnoid villi–like structure. OBSERVATIONS: A 20-year-old woman presented with progressive severe headache and posterior neck pain. Magnetic resonance imaging showed tonsillar herniation and decreased subarachnoid space around the spinal cord. A hypointense signal area was observed in the ventral spinal canal on a T2-weighted image. An axial image revealed multiple small, arachnoid cyst–like structures at the right T1 nerve root sleeve. Direct surgery revealed that the cyst-like structures were continuous with the arachnoid membrane and protruded into the abnormally large epidural venous sinus. The cyst-like structures were resected, and the dural sleeve was repaired using fascia. The patient showed good improvement of symptoms after surgery. LESSONS: Excessive CSF absorption through the enlarged spinal arachnoid villi–like structure can cause secondary Chiari malformation. Neurosurgeons should be aware of this unusual mechanism of CSF leakage. Simple posterior fossa decompression will be ineffective or even harmful.
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spelling pubmed-92413182022-07-18 Secondary Chiari malformation due to enlarged spinal arachnoid villi–like structure: illustrative case Koyanagi, Izumi Chiba, Yasuhiro Imamura, Hiroyuki Yoshino, Masami Aida, Toshimitsu J Neurosurg Case Lessons Case Report BACKGROUND: Secondary Chiari malformation can be caused by various disorders associated with cerebrospinal fluid (CSF) leakage at the spinal level. In this report, the authors describe a rare case of secondary Chiari malformation caused by excessive CSF absorption through the enlarged spinal arachnoid villi–like structure. OBSERVATIONS: A 20-year-old woman presented with progressive severe headache and posterior neck pain. Magnetic resonance imaging showed tonsillar herniation and decreased subarachnoid space around the spinal cord. A hypointense signal area was observed in the ventral spinal canal on a T2-weighted image. An axial image revealed multiple small, arachnoid cyst–like structures at the right T1 nerve root sleeve. Direct surgery revealed that the cyst-like structures were continuous with the arachnoid membrane and protruded into the abnormally large epidural venous sinus. The cyst-like structures were resected, and the dural sleeve was repaired using fascia. The patient showed good improvement of symptoms after surgery. LESSONS: Excessive CSF absorption through the enlarged spinal arachnoid villi–like structure can cause secondary Chiari malformation. Neurosurgeons should be aware of this unusual mechanism of CSF leakage. Simple posterior fossa decompression will be ineffective or even harmful. American Association of Neurological Surgeons 2021-01-11 /pmc/articles/PMC9241318/ /pubmed/35854931 http://dx.doi.org/10.3171/CASE2049 Text en © 2021 The authors https://creativecommons.org/licenses/by-nc-nd/4.0/CC BY-NC-ND 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ).
spellingShingle Case Report
Koyanagi, Izumi
Chiba, Yasuhiro
Imamura, Hiroyuki
Yoshino, Masami
Aida, Toshimitsu
Secondary Chiari malformation due to enlarged spinal arachnoid villi–like structure: illustrative case
title Secondary Chiari malformation due to enlarged spinal arachnoid villi–like structure: illustrative case
title_full Secondary Chiari malformation due to enlarged spinal arachnoid villi–like structure: illustrative case
title_fullStr Secondary Chiari malformation due to enlarged spinal arachnoid villi–like structure: illustrative case
title_full_unstemmed Secondary Chiari malformation due to enlarged spinal arachnoid villi–like structure: illustrative case
title_short Secondary Chiari malformation due to enlarged spinal arachnoid villi–like structure: illustrative case
title_sort secondary chiari malformation due to enlarged spinal arachnoid villi–like structure: illustrative case
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9241318/
https://www.ncbi.nlm.nih.gov/pubmed/35854931
http://dx.doi.org/10.3171/CASE2049
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