CC BY-NC-ND 4.0 · J Neurol Surg Rep 2023; 84(01): e26-e30
DOI: 10.1055/a-2028-6419
Case Report

Use of Intraoperative Neuromonitoring in Surgical Treatment of Acute Presentation of Chiari I Malformation: A Case Report

1   School of Medicine, New York Medical College, Valhalla, New York, United States
,
Sima Vazquez
1   School of Medicine, New York Medical College, Valhalla, New York, United States
,
Rose Auerbach-Tash
2   Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, United States
,
Alexandria F. Naftchi
1   School of Medicine, New York Medical College, Valhalla, New York, United States
,
2   Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, United States
,
3   Division of Pediatric Critical Care, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, United States
,
Philip Overby
4   Division of Pediatric Neurology, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, United States
,
Carrie R. Muh
5   Division of Pediatric Neurosurgery, Westchester Medical Center, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, United States
› Author Affiliations

Abstract

Intraoperative neuromonitoring (IONM) has been used in neurosurgical procedures to assess patient safety and minimize risk of neurological deficit. However, its use in decompressive surgeries of Chiari malformation type I (CM-I) remains a topic of debate. Here we present the case of a 5-year-old girl who presented with acute right lower extremity monoplegia after accidental self-induced hyperflexion of the neck while playing. Imaging revealed 15 mm of tonsillar ectopia with cervical and upper thoracic spinal cord edema. She was taken to surgery for a suboccipital decompression with expansile duraplasty. IONM demonstrated improvement in motor evoked potentials during the decompression. Postoperatively, she had full recovery of strength and mobility. This is a case of acute weakness after mild trauma in the setting of previously asymptomatic CM-I that showed close correlation with IONM, clinical findings, and imaging. IONM during decompressive surgery for CM-I may be useful in patients who present acutely with cervical cord edema.



Publication History

Received: 04 July 2022

Accepted: 26 January 2023

Accepted Manuscript online:
04 February 2023

Article published online:
13 March 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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