Subdural Fluid Collection and Hydrocephalus After Foramen Magnum Decompression for Chiari Malformation Type I: Management Algorithm of a Rare Complication

World Neurosurg. 2017 Oct;106:1057.e9-1057.e15. doi: 10.1016/j.wneu.2017.07.112. Epub 2017 Jul 25.


Background: Chiari malformation type I is a hindbrain abnormality characterized by descent of the cerebellar tonsils beneath the foramen magnum, frequently associated with symptoms or brainstem compression, impaired cerebrospinal fluid circulation, and syringomyelia. Foramen magnum decompression represents the most common way of treatment. Rarely, subdural fluid collection and hydrocephalus represent postoperative adverse events. The treatment of this complication is still debated, and physicians are sometimes uncertain when to perform diversion surgery and when to perform more conservative management.

Case description: We report an unusual occurrence of subdural fluid collection and hydrocephalus that developed in a 23-year-old patient after foramen magnum decompression for Chiari malformation type I. Following a management protocol, based on a step-by-step approach, from conservative therapy to diversion surgery, the patient was managed with urgent external ventricular drainage, and then with conservative management and wound revision.

Conclusions: Because of the rarity of this adverse event, previous case reports differ about the form of treatment. In future cases, finding clinical and radiologic features to identify risk factors that are useful in predicting if the patient will benefit from conservative management or will need to undergo diversion surgery is only possible if a uniform form of treatment is used. Therefore, we believe that a management algorithm based on a step-by-step approach will reduce the use of invasive therapies and help to create a standard of care.

Keywords: Chiari malformation type I; Foramen magnum decompression complication; Hydrocephalus; Subdural hygroma.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Algorithms
  • Arnold-Chiari Malformation / diagnosis
  • Arnold-Chiari Malformation / surgery*
  • Decompression, Surgical / adverse effects*
  • Decompression, Surgical / methods
  • Female
  • Foramen Magnum / surgery*
  • Humans
  • Hydrocephalus / diagnosis
  • Hydrocephalus / etiology
  • Hydrocephalus / surgery*
  • Postoperative Complications*
  • Subdural Effusion / diagnosis
  • Subdural Effusion / etiology
  • Subdural Effusion / surgery*
  • Young Adult