The evolution of cerebellar tonsillar herniation after cranial vault remodeling surgery

Purpose We sought to examine the pre- and postoperative changes of cerebellar tonsillar herniation by MR imaging in asymptomatic pediatric patients with nonsyndromic, single-suture craniosynostosis (N-SSSC), who underwent cranial vault remodeling surgery without suboccipital decompression. We requir...

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Bibliographic Details
Published in:Child's nervous system 2012-10, Vol.28 (10), p.1767-1771
Main Authors: Leikola, J., Hukki, A., Karppinen, A., Valanne, L., Koljonen, V.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Arnold-Chiari Malformation - surgery
Child
Craniosynostoses - surgery
Encephalocele - etiology
Female
Humans
Magnetic Resonance Imaging
Male
Medicine
Medicine & Public Health
Meningocele - etiology
Middle Aged
Neurosciences
Neurosurgery
Original Paper
Postoperative Complications
Retrospective Studies
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Summary:Purpose We sought to examine the pre- and postoperative changes of cerebellar tonsillar herniation by MR imaging in asymptomatic pediatric patients with nonsyndromic, single-suture craniosynostosis (N-SSSC), who underwent cranial vault remodeling surgery without suboccipital decompression. We required cerebellar tonsillar herniation through foramen magnum ≥3 mm for Chiari type I malformation (CMI). We hypothesized that the increase of intracranial volume by cranial vault remodeling would correct the asymptomatic CMI. Methods We identified 9 patients among 121 N-SSSC children undergoing craniofacial surgery from January 2004 to October 2010 with CMI. However, two of them were excluded from the study due to missing postoperative MR images. In the final study population, six were males, five were scaphocephalic, while two were diagnosed with coronal synostosis. Results In four of the cases, the CMI was decreased in postoperative MR imaging varying from 6 to 12 mm. In three cases, the herniation remained stable. The median change of cerebellar tonsillar herniation was −6.5 mm. Conclusions We conclude that asymptomatic patients with existing CMI may benefit from cranial vault remodeling surgery alone increasing the intracranial volume.
ISSN:0256-7040
1433-0350
DOI:10.1007/s00381-012-1816-7