Endoscopic Endonasal Resection of Cranio-Cervical Junction Chordoma and Ventral Chiari Decompression: A Case Report. Issue 5 (14th August 2021)

• Record Type: Journal Article
• Authors: Muthiah, Nallammai; McDowell, Michael M; Zenonos, Georgios; Agarwal, Nitin; Snyderman, Carl H; Friedlander, Robert M; Gardner, Paul A
• Is Part Of: Operative neurosurgery. Volume 21:Issue 5(2021)
• Page Start: E421
• Page End: E426
• Publication Date: 2021-08-14
• Subjects: Chiari 1 malformation -- Chordoma -- Endoscopic endonasal approach -- Ventral decompression; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1093/ons/opab285
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract: BACKGROUND: Chiari I malformations secondary to other causes represent a small subset of presenting symptomatic cases. Typically, the primary cause of the malformation is addressed first and results in resolution of the malformation and symptoms. However, in some cases, a patient may present with both a primary Chiari I malformation and another unrelated neurosurgical lesions. OBJECTIVE: To present a unique case in which resection of a ventral tumor allowed for spontaneous resolution of a simultaneously noted dorsal Chiari I malformation. METHODS: Pertinent data, including presenting symptoms, hospital course, surgical notes, preoperative images, and postoperative images, were collected using the electronic medical record. RESULTS: We present a case of a 46-yr-old man with a Chiari I malformation in conjunction with a ventral cranio-cervical junction chordoma. Endoscopic endonasal resection of the chordoma and ventral foramen magnum decompression resulted in radiographic resolution of the Chiari malformation and resolution of his symptoms. Our report represents a rare case of ventral foramen magnum decompression as a treatment for Chiari I malformation. CONCLUSION: It is felt that the chordoma mass effect was not the source of the Chiari I malformation. Thus, both ventral and dorsal decompressions of the posterior fossa may be considered for Chiari I decompression in select circumstances.