Endoscopic third ventriculostomy for treatment of noncommunicating syringomyelia associated with a Chiari I malformation and hydrocephalus: Case report and pathophysiological considerations

Philippe Métellus, Henry Dufour, Olivier Levrier, François Grisoli, Alan R. Cohen, Edward C. Benzel, Ulrich Batzdorf, Thomas H. Milhorat

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE AND IMPORTANCE: A Chiari I malformation associated with syringomyelia and hydrocephalus is a rare condition. We report the successful use of endoscopic third ventriculostomy for the treatment of this pathological entity. The successful use of this technique in such a case has not been previously described, and the results allow us to speculate on the pathophysiological mechanism involved. CLINICAL PRESENTATION: A 34-year-old woman presented with headaches, a motor deficit of the right upper limb, and gait dyspraxia. Magnetic resonance imaging scans demonstrated dilation of all ventricles, compression of the retrocerebellar cerebrospinal fluid space, downward displacement of the tonsils, and syringomyelia. Syringomyelia involved the cervicodorsal cord below C3, with a syrinx-free segment between C1 and C3 and no enlargement of the rostral part of the central canal. INTERVENTION: Endoscopic third ventriculostomy resulted in prompt improvement of the clinical symptoms. Postoperative magnetic resonance imaging scans demonstrated shrinkage of the syrinx and return of the cerebellar tonsils to their physiological positions. CONCLUSION: This experience demonstrates that endoscopic third ventriculostomy, which is a simple, safe technique, may be the treatment of choice for associated Chiari I malformations, hydrocephalus, and syringomyelia (even the noncommunicating type).

Original languageEnglish (US)
Pages (from-to)500-504
Number of pages5
JournalNeurosurgery
Volume51
Issue number2
DOIs
StatePublished - Aug 1 2002
Externally publishedYes

Keywords

  • Chiari I malformation
  • Hydrocephalus
  • Syringomyelia
  • Third ventriculostomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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