The use of the trendelenburg position in the surgical treatment of extreme cerebellar slump

Background. State-of-the-art treatment for Chiari Malformation I (CM-I) consists of decompression by posterior fossa craniectomy. A rare but severe complication that develops over months to years after this procedure is cerebellar slump. Treatment options for this condition are limited. We present a...

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Bibliographic Details
Published in:British journal of neurosurgery 2016-01, Vol.30 (1), p.115-119
Main Authors: Dewaele, Frank, Kalmar, Alain F., Baert, Edward, Van Haver, Annemieke, Hallaert, Giorgio, De Mets, Frank, Williams, Leonie, Kalala Okito, Jean Pierre, Paemeleire, Koen, Caemaert, Jacques, Van Roost, Dirk
Format: Article
Language:English
Subjects:
Adult
Arnold-Chiari Malformation - diagnosis
Arnold-Chiari Malformation - surgery
Brain
brainstem
cerebellar
Cerebellum - surgery
Cranial Fossa, Posterior - surgery
Craniotomy - methods
Decompression, Surgical - methods
Dura Mater - surgery
Humans
Male
Medical treatment
Morphology
Neurosurgery
Reconstructive Surgical Procedures
slump
Syringomyelia - diagnosis
Syringomyelia - surgery
Trendelenburg
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Summary:Background. State-of-the-art treatment for Chiari Malformation I (CM-I) consists of decompression by posterior fossa craniectomy. A rare but severe complication that develops over months to years after this procedure is cerebellar slump. Treatment options for this condition are limited. We present a new and promising approach to treat this rare condition. Methods. The patients were placed in the Trendelenburg position to facilitate ascent of the cerebellum. After almost complete dissolution of neurologic symptoms, surgical reconstruction was performed by tonsillar resection and the creation of a new structural support using a bone graft. Results. Both patients experienced good clinical and morphological outcomes immediately after surgery, and for two years thereafter. Conclusions. Neurological symptoms related to cerebellar or brainstem slump can be adequately reversed by placing the patient in the Trendelenburg position. After uneventful gravitational reversal of the slump, safe surgical reconstruction of the cerebellar support can be performed to securely preserve the anatomical reversal.
ISSN:0268-8697
1360-046X
DOI:10.3109/02688697.2015.1073220