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Symptomatic Chiari type I malformation after radiation therapy in an infant: case report.

Hoffman CE, Lis E, Wolden SL, Souweidane MM

Department of Neurological Surgery, Weill Medical College of Cornell University, New York, New York 10021, USA.

OBJECTIVE: One previous case report has described the development of a Chiari I malformation in a child after fractionated radiation therapy to the anterior cranial base. The authors present an additional case of a 17-month-old girl treated for an isolated, malignant, rhabdoid tumor of the right neck with neoadjuvant chemotherapy, surgical exploration, and radiation therapy. CLINICAL PRESENTATION: The patient developed a Chiari I malformation and cervical syringomyelia 1.5 years after the treatment. The patient experienced two episodes of unresponsiveness before diagnosis, and the malformation was then identified on magnetic resonance imaging scans. INTERVENTION: Suboccipital decompressive craniectomy, and C1 laminectomy with autologous duraplasty were performed. RESULTS: Postoperative magnetic resonance imaging scans revealed reconstitution of cerebrospinal fluid at the foramen magnum and ascent of the cerebellar tonsils. The patient remains asymptomatic 5.5 years after treatment. CONCLUSION: The importance of this association is discussed in the context of the increasing use of radiation therapy in young children and infants.

Published 6 April 2007 in Neurosurgery, 60(4): E782; discussion E782.
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