Abstract
Chiari I malformation is the herniation of cerebellar tonsils below the level of the foramen magnum due to congenital or acquired pathologies. Acquired Chiari I malformation (ACM) may occur secondary to space-occupying lesions (SOLs), such as intracranial tumors due to elevated intracranial pressure (ICP), and can be accompanied by syringomyelia. ACM and syringomyelia have been shown to resolve after resection of the SOL, without the need for adjuvant posterior fossa decompression. The vast majority of SOLs leading to ACM have been reported in the posterior fossa, thus exerting a direct mass effect on the cerebellum. Supratentorial SOLs leading to ACM are much less frequent but, when present, are most commonly parieto-occipital. We report a rare case of a large anterior left frontal, parasagittal meningioma causing ACM and syringomyelia. These findings resolved following the resection of the meningioma, with no further surgical intervention. Our case demonstrates that ACM can occur secondary to an anterior supratentorial mass and further supports the idea that decompression of the posterior fossa is not required for the resolution of intracranial tumor-associated ACM and syringomyelia.
Highlights
Chiari I malformation (CIM) refers to the caudal herniation of the cerebellar tonsils for a variable distance below the foramen magnum
We report a rare case of a large anterior left frontal, parasagittal meningioma causing Acquired Chiari I malformation (ACM) and syringomyelia
Surgery to decompress the posterior fossa is often indicated if the CIM causes symptoms of the spinal cord or medullary compression, significant pain secondary to increases in intracranial pressure (ICP), or neurologic deficits linked to syringomyelia [1]
Summary
Chiari I malformation (CIM) refers to the caudal herniation of the cerebellar tonsils for a variable distance below the foramen magnum. Acquired Chiari I malformation (ACM) may arise secondary to space-occupying lesions (SOLs) such as meningiomas In these patients, the SOL may be resected, resolving the ACM and syringomyelia without the need for posterior fossa decompression. The MRI demonstrated cerebellar tonsillar herniation and cervical syringomyelia (Figure 1D). D. Sagittal T2 imaging of the cervical spine demonstrates tonsillar herniation (red arrow) below McRae’s line and cervical syringomyelia (white arrow). At seven months after the procedure, MRI of the brain (left) showed (A) no tumor recurrence (blue arrow on T1 + gadolinium image) and (B) near-complete resolution of the peritumoral edema (green arrow on FLAIR image). The cervical spine MRI demonstrated resolution of the tonsillar herniation (red arrow) and cervical syrinx (white arrow)
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