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Case Reports
. 2016 Jul-Sep;11(3):311-2.
doi: 10.4103/1793-5482.179643.

Acute obstructive hydrocephalus complicating decompression surgery of the craniovertebral junction

Junichi Ohya  1 , Hirotaka Chikuda  1 , Hirofumi Nakatomi  2 , Ryuji Sakamoto  1 , Nobuhito Saito  2 , Sakae Tanaka  1
Affiliations
Case Reports

Acute obstructive hydrocephalus complicating decompression surgery of the craniovertebral junction

Junichi Ohya et al. Asian J Neurosurg. 2016 Jul-Sep.

Abstract

Obstructive hydrocephalus has been described as a rare complication following foramen magnum decompression for Chiari malformation. However, there are few reports of obstructive hydrocephalus after spinal surgery for other pathologies of the craniovertebral junction (CVJ). The authors herein report a 52-year-old female with achondroplasia presenting with an 8-month history of myelopathy due to spinal cord compression at CVJ. She underwent resection of the C1 posterior arch and part of the edge of the occipital bone. A computed tomography (CT) scan obtained 1-week after the surgery revealed bilateral infratentorial fluid collection. The patient was first managed conservatively; however, on the 17(th) day, her consciousness level showed sudden deterioration. Emergency CT demonstrated marked hydrocephalus due to obstruction of the cerebral aqueduct. Acute obstructive hydrocephalus can occur late after decompression surgery at the CVJ, and thus should be included in the differential diagnosis of a deteriorating mental status.

Keywords: Achondroplasia; complication; craniovertebral junction; obstructive hydrocephalus; remote cerebellar hemorrhage.

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Figures

Figure 1
Figure 1
Plain lateral radiographs (a) and sagittal computed tomography (b) of the cervical spine revealing congenital bony canal stenosis at the CVJ caused by the C1 posterior arch and occipital bone
Figure 2
Figure 2
Sagittal magnetic resonance imaging (a) and axial imaging at the C1 level (b) demonstrating an atrophied spinal cord and high-intensity intramedullary lesion
Figure 3
Figure 3
Intraoperative photographs after resection of the posterior arch and part of the occipital bone (a) the thickened reactive fibrous tissue band compressing the dural mater (arrow). Following the removal of the fibrous tissue band with opening of the dura mater, decompression of the spinal cord was achieved (b)
Figure 4
Figure 4
Plain brain computed tomography obtained 7 days after surgery (a) infratentorial fluid collection bilaterally (arrowheads). On the 17th day (b), the infratentorial fluid collection increased
Figure 5
Figure 5
Plain brain computed tomography obtained 17 days after surgery revealing enlargement of the lateral ventricles (a) and an obstructed cerebral aqueduct (b, arrow), which indicated the presence of obstructive hydrocephalus
See this image and copyright information in PMC

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