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  • Title: Resolution of Chiari malformation after repair of a congenital thoracic meningocele: case report and literature review.
    Author: Madhok R, Mazzola CA, Pollack IF.
    Journal: Neurosurgery; 2002 Dec; 51(6):1489-91; discussion 1491-2. PubMed ID: 12445356.
    Abstract:
    OBJECTIVE AND IMPORTANCE: Many theories have been proposed regarding potential causative factors for Chiari malformations. An unusual case is described in which regression of a congenital Chiari malformation was observed after repair of a thoracic meningocele without direct surgical intervention to decompress the craniocervical junction. This supports the importance of an in utero craniospinal pressure gradient as a potential cause for congenital, but reversible, cerebellar herniation. CLINICAL PRESENTATION: A newborn baby was observed to have a thoracic meningocele. Magnetic resonance imaging scan revealed a concomitant Chiari malformation. No neurological deficits were present at initial examination. INTERVENTION: The patient underwent surgical closure of the thoracic meningocele and untethering of the spinal cord at the site of the dural defect. A postoperative magnetic resonance imaging scan obtained 3 months after the operation revealed complete resolution of the cerebellar herniation. CONCLUSION: The resolution of the Chiari malformation in this child may have resulted from restoration of normal cerebrospinal fluid flow and elimination of the meningocele-related cerebrospinal fluid pressure gradient between the intracranial and intraspinal compartments.
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