-Case Reports-

Syringomyelia Associated with Chiari I Malformation Treated with Foramen Magnum Decompression and Duraplasty Using a Polyglycolic Acid Patch and Fibrin Glue: A Case Report

Atsushi Sugawara¹, Toyohiko Isu², Kyongsong Kim³, Ryoji Matsumoto², Masanori Isobe² and Kuniaki Ogasawara¹

¹Department of Neurosurgery, Iwate Medical University School of Medicine
²Department of Neurosurgery, Kushiro Rosai Hospital
³Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital

A 31-year-old woman presented with worsening numbness and pain in the arms and chest. Neurological findings at admission were decreased pain sensation and temperature sensation in the arms and chest. Magnetic resonance demonstrated a large cervical syrinx from the level of C4 to Th4 associated with Chiari I malformation. Occipital craniectomy and C1 laminectomy were performed for foramen magnum decompression. Intraoperative ultrasonography, performed after removal of the outer membrane of the dura mater at the level of the foramen magnum, revealed insufficient decompression. Therefore, the dura mater was completely opened and duraplasty was performed with a polyglycolic acid patch and fibrin glue. Sufficient decompression was thus achieved. The neurological symptoms and signs improved within the first postoperative month, and magnetic resonance showed a decrease in the size of the syrinx and no cerebrospinal fluid leakage. In patients undergoing foramen magnum decompression with duraplasty, the use of a polyglycolic acid patch and fibrin glue renders suturing unnecessary and avoids the common complications associated with suture duraplasty.

J Nippon Med Sch 2010; 77: 221-225

Keywords
syringomyelia, Chiari malformation I, foramen magnum decompression, polyglycolic acid, duraplasty

Correspondence to
Atsushi Sugawara, Department of Neurosurgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan
asuga@iwate-med.ac.jp

Received, March 30, 2010
Accepted, April 20, 2010