Vertebrobasilar Insufficiency Due to Distal Posterior Inferior Cerebellar Artery Compression in Chiari 1.5.

Vertebrobasilar Insufficiency Due to Distal Posterior Inferior Cerebellar Artery Compression in Chiari 1.5.

World Neurosurg. 2017 Jun 02;:

Authors: Janjua MB, Ivasyk I, Greenfield JP

Abstract
Chiari malformation is characterized by radiographic evidence of herniation of cerebellar tonsils below the foramen magnum, and symptoms complex of headaches, breathing, swallowing or sleep difficulties, ataxia, restless, motor and/or sensory deficits. We report a case of a 34-year old female whose imaging indicated a Chiari 1.5 with brainstem (caudal medulla) herniation, and an expansive cervical syrinx. Her symptom complex showed signs both of cervical syringomyelia, as well as ones localizable to the medulla. An intradural exploration revealed the occlusion and caudal displacement of the loop of the right PICA which was later confirmed via magnetic resonance angiogram. In the setting of severe Chiari malformations, particularly the Chiari 1.5 variant, assessment of the posterior fossa vasculature may be useful in defining a subset of patients with pre-operative compromise in posterior fossa blood flow and post-operative expectations. Preoperative planning and exploration of midline dorsal brain stem along with the tonsilomedullary fissure could be helpful for contribution of vascular pathology among Chiari symptoms complex in these patients.

PMID: 28583457 [PubMed - as supplied by publisher]

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