Chiari I: Edema Medular y Aumento de la Siringomielia luego de la Descompresión Cráneo Espinal con Plástica Meníngea. Reporte de un caso

Objective: to describe and analyze a Chiari I malformation with spinal cord edema and syrinx increase after craneospinal decompression (CED). Description: a 57 years-old female referred a history of headaches after Valsalva maneuvers, hiccup, dysphagia and left distal upper limb hypoesthesia. Magnetic Resonance Imaging (MRI) showed a Chiari I malformation with syringomyelia. Intervention: during April 2009 a CED (occipital + atlas) with a non autologous duraplasty were performed. In the immediate postoperative period headaches increased and also appeared an external CSF fistula that was treated successfully with an external lumbar drainage. As the pre and postoperative symptoms improved she was discharged. After 15 days MRI revealed a pseudomeningocele (PMC) with spinal cord edema. Further controls showed the disappearance of the PMC and the edema with syrinx increase. In March 2011 a laminectomy of the axis was performed without reduction of the syrinx. A few months later and after a cough attack a neuropathic pain developed in the left upper limb. MRI showed a larger syrinx with retraction of the duraplasty. In December 2011 a new duraplasty with autologous pericranium was performed. Three months latter a postoperative MRI showed syrinx resolution. Conclusion: in this case the spinal cord edema and PMC resolved spontaneously but syringomyelia improved only after removing all the causes that obstructed the normal CSF circulation at the foramen magnum.