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Clinical Report

Chiari I Malformation

Dr. John Honeycutt, Medical Director, Neuro-Trauma
Cook Children’s Medical Center Fort Worth, Texas

PATIENT INFO: 3 ½ year-old female with hypoplastic heart experiencing several seizures; minor complaints of occasional headaches and leg pains; slightly hyperreflexic but otherwise normal

SUMMARY: Preoperative MRI showed severe Chiari I malformation with severe cervical and thoracic syringomyelia. For surgery in intraoperative MR suite, patient was placed in prone position with head fixated to the bed with 3-pin head holder. Baseline MRI consisted of sagittal T1 and T2 images with CINE flow study. Patient then underwent boney decompression with thinning of dura. Another intraoperative MRI was obtained showing good decompression with CINE flow showing improved flow. Operation stopped and dura was not opened.

Postoperative imaging showed syrinx much smaller and subsequently headaches and leg complaints had resolved.