Abstract
Background: Chiari malformation type 1 (CM-1) is a generally congenital, rarely acquired disease characterized with 5 mm or more displacement of cerebellar tonsils through foramen magnum. Methods: Here, we report about 2 patients with CM-1 progressed in the degree of tonsillar herniation from our clinic, whereas increasing in prolapse of tonsillar herniation after diagnosis is extremely uncommon. Results: The first patient aged 17 years was diagnosed with CM-1 in 2009 and was operated due to progression of 5 mm radiologically and worsening symptoms in 2014. The second 5-month-old patient initially showed just low-settled tonsillar localization at the borderline, then it descended by 2 cm when the patient reached 3 years of age, yet could not be operated because of parents’ objection. Conclusion: Due to lack of reports on increasing tonsillar descent in the literature, these case reports will contribute to natural history and management of CM-1.
References
1.
Osborn
AG
. Osborn’s Brain Radiology, Pathology and Anatomy
. Neuroophthalmology
. 2014
;38
(2
):96
–7
. 0165-81072.
Schijman
E
. History, anatomic forms, and pathogenesis of Chiari I malformations
. Childs Nerv Syst
. 2004
May
;20
(5
):323
–8
.
[PubMed]
0256-70403.
Pomeraniec
IJ
, Ksendzovsky
A
, Awad
AJ
, Fezeu
F
, Jane
JA
Jr. Natural and surgical history of Chiari malformation Type I in the pediatric population
. J Neurosurg Pediatr
. 2016
Mar
;17
(3
):343
–52
.
[PubMed]
1933-07074.
Greenberg
JK
, Olsen
MA
, Yarbrough
CK
, Ladner
TR
, Shannon
CN
, Piccirillo
JF
, et al. Chiari malformation Type I surgery in pediatric patients. Part 2: complications and the influence of comorbid disease in California, Florida, and New York
. J Neurosurg Pediatr
. 2016
May
;17
(5
):525
–32
.
[PubMed]
1933-07075.
Novegno
F
, Caldarelli
M
, Massa
A
, Chieffo
D
, Massimi
L
, Pettorini
B
, et al. The natural history of the Chiari Type I anomaly
. J Neurosurg Pediatr
. 2008
Sep
;2
(3
):179
–87
.
[PubMed]
1933-07076.
Benglis
D
Jr, Covington
D
, Bhatia
R
, Bhatia
S
, Elhammady
MS
, Ragheb
J
, et al. Outcomes in pediatric patients with Chiari malformation Type I followed up without surgery
. J Neurosurg Pediatr
. 2011
Apr
;7
(4
):375
–9
.
[PubMed]
1933-07077.
Sun
PP
, Harrop
J
, Sutton
LN
, Younkin
D
. Complete spontaneous resolution of childhood Chiari I malformation and associated syringomyelia
. Pediatrics
. 2001
Jan
;107
(1
):182
–4
.
[PubMed]
0031-40058.
Jack
CR
Jr, Kokmen
E
, Onofrio
BM
. Spontaneous decompression of syringomyelia: magnetic resonance imaging findings. Case report
. J Neurosurg
. 1991
Feb
;74
(2
):283
–6
.
[PubMed]
0022-30859.
Klekamp
J
, Iaconetta
G
, Samii
M
. Spontaneous resolution of Chiari I malformation and syringomyelia: case report and review of the literature
. Neurosurgery
. 2001
Mar
;48
(3
):664
–7
.
[PubMed]
0148-396X10.
Guillen
A
, Costa
JM
. Spontaneous resolution of a Chiari I malformation associated syringomyelia in one child
. Acta Neurochir (Wien)
. 2004
Feb
;146
(2
):187
–91
.
[PubMed]
0001-626811.
Avellino
AM
, Britz
GW
, McDowell
JR
, Shaw
DW
, Ellenbogen
RG
, Roberts
TS
. Spontaneous resolution of a cervicothoracic syrinx in a child. Case report and review of the literature
. Pediatr Neurosurg
. 1999
Jan
;30
(1
):43
–6
.
[PubMed]
1016-229112.
Williams
A
, Kamat
A
, Palmer
J
. Radiological demonstration of spontaneous resolution of type 1 Chiari malformation in a 17-year-old patient
. Br J Neurosurg
. 2011
Dec
;25
(6
):764
–5
.
[PubMed]
0268-869713.
Briganti
F
, Leone
G
, Briganti
G
, Orefice
G
, Caranci
F
, Maiuri
F
. Spontaneous resolution of Chiari type 1 malformation. A case report and literature review
. Neuroradiol J
. 2013
Jun
;26
(3
):304
–9
.
[PubMed]
1971-400914.
Strahle
J
, Muraszko
KM
, Kapurch
J
, Bapuraj
JR
, Garton
HJ
, Maher
CO
. Natural history of Chiari malformation Type I following decision for conservative treatment
. J Neurosurg Pediatr
. 2011
Aug
;8
(2
):214
–21
.
[PubMed]
1933-070715.
Marin-Padilla
M
, Marin-Padilla
TM
. Morphogenesis of experimentally induced Arnold—chiari malformation
. J Neurol Sci
. 1981
Apr
;50
(1
):29
–55
.
[PubMed]
0022-510X16.
McLone
DG
, Knepper
PA
. The cause of Chiari II malformation: a unified theory
. Pediatr Neurosci
. 1989
;15
(1
):1
–12
.
[PubMed]
0255-797517.
Nishikawa
M
, Sakamoto
H
, Hakuba
A
, Nakanishi
N
, Inoue
Y
. Pathogenesis of Chiari malformation: a morphometric study of the posterior cranial fossa
. J Neurosurg
. 1997
Jan
;86
(1
):40
–7
.
[PubMed]
0022-308518.
Ranger
A
, Al-Hayek
A
, Matic
D
. Chiari type 1 malformation in an infant with type 2 Pfeiffer syndrome: further evidence of acquired pathogenesis
. J Craniofac Surg
. 2010
Mar
;21
(2
):427
–31
.
[PubMed]
1049-227519.
Nishizawa
S
, Yokoyama
T
, Yokota
N
, Tokuyama
T
, Ohta
S
. Incidentally identified syringomyelia associated with Chiari I malformations: is early interventional surgery necessary?
Neurosurgery
. 2001
Sep
;49
(3
):637
–40
.
[PubMed]
0148-396X20.
Lipson
AC
, Ellenbogen
RG
, Avellino
AM
. Radiographic formation and progression of cervical syringomyelia in a child with untreated Chiari I malformation
. Pediatr Neurosurg
. 2008
;44
(3
):221
–3
.
[PubMed]
1016-229121.
Mikulis
DJ
, Diaz
O
, Egglin
TK
, Sanchez
R
. Variance of the position of the cerebellar tonsils with age: preliminary report
. Radiology
. 1992
Jun
;183
(3
):725
–8
.
[PubMed]
0033-841922.
Hatae
R
, Kohri
R
, Maeda
K
, Miyazono
M
. A rare case of Chiari type-1 malformation accompanied by symptomatic cerebrospinal fluid hypovolemia: comparison of congenital Chiari type-1 malformation and acquired Chiari malformation secondary to cerebrospinal fluid hypovolemia: case report
. Neurol Med Chir (Tokyo)
. 2014
;54
(7
):558
–62
.
[PubMed]
0470-810523.
Istek
S
. Chiari type 1 malformation in a pseudotumour cerebri patient: is it an acquired or congenital Chiari malformation?
BMJ Case Rep
. 2014
Jun
;2014
jun04 1
:2014
.
[PubMed]
1757-790X24.
Ramón
C
, Gonzáles-Mandly
A
, Pascual
J
. What differences exist in the appropriate treatment of congenital versus acquired adult Chiari type I malformation?
Curr Pain Headache Rep
. 2011
Jun
;15
(3
):157
–63
.
[PubMed]
1531-343325.
Vilming
ST
, Mokri
B
. Low cerebrospinal fluid pressure. In: Olesen
J
, Goadsby
PJ
, Ramadan
NM
, Tfelt-Hansen
P
, Welch
KM
, editors. The headaches
. 3rd ed. Philadelphia
: Lippincott Williams & Wilkins
; 2006
. pp. 935
–44
.26.
Caldarelli
M
, Novegno
F
, Di Rocco
C
. A late complication of CSF shunting: acquired Chiari I malformation
. Childs Nerv Syst
. 2009
Apr
;25
(4
):443
–52
.
[PubMed]
0256-704027.
Roohi
F
, Gropen
T
, Kula
RW
. Sudden unexpected nocturnal death in Chiari type 1 malformation and potential role of opioid analgesics
. Surg Neurol Int
. 2014
Feb
;5
(5
):17
.
[PubMed]
2229-509728.
Tubbs
RS
, Lyerly
MJ
, Loukas
M
, Shoja
MM
, Oakes
WJ
. The pediatric Chiari I malformation: a review
. Childs Nerv Syst
. 2007
Nov
;23
(11
):1239
–50
.
[PubMed]
0256-704029.
Durham
SR
, Fjeld-Olenec
K
. Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis
. J Neurosurg Pediatr
. 2008
Jul
;2
(1
):42
–9
.
[PubMed]
1933-070730.
Hankinson
T
, Tubbs
RS
, Wellons
JC
. Duraplasty or not? An evidence-based review of the pediatric Chiari I malformation
. Childs Nerv Syst
. 2011
Jan
;27
(1
):35
–40
.
[PubMed]
0256-704031.
Malik
A
, Chandra
R
, Misra
R
, Thukral
BB
. Chiari 1.5: A lesser known entity
. Ann Indian Acad Neurol
. 2015
Oct-Dec
;18
(4
):449
–50
.
[PubMed]
0972-232732.
Tubbs
RS
, Iskandar
BJ
, Bartolucci
AA
, Oakes
WJ
. A critical analysis of the Chiari 1.5 malformation
. J Neurosurg
. 2004
Nov
;101
(2
Suppl
):179
–83
.
[PubMed]
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