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

Christina Ng; Sima Vazquez; Rose Auerbach-Tash; Alexandria F. Naftchi; Jose F. Dominguez; Aalok R. Singh; Philip Overby; Carrie R. Muh

doi:10.1055/a-2028-6419

Journal of Neurological Surgery Reports, Table of Contents

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

Authors

Christina Ng

¹School of Medicine, New York Medical College, Valhalla, New York, United States
Sima Vazquez

¹School of Medicine, New York Medical College, Valhalla, New York, United States
Rose Auerbach-Tash

²Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, United States
Alexandria F. Naftchi

¹School of Medicine, New York Medical College, Valhalla, New York, United States
Jose F. Dominguez

²Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, United States
Aalok R. Singh

³Division of Pediatric Critical Care, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, United States
Philip Overby

⁴Division of Pediatric Neurology, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, United States
Carrie R. Muh

⁵Division of Pediatric Neurosurgery, Westchester Medical Center, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, United States

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.

Keywords

acute chiari - intraoperative neuromonitoring - decompression - chiari I malformation

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References

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