R. NICKBRYANMDS. JAMESZINREICHMD
The findings of MRI were consistent with a Chiari type I malformation (the cerebellar tonsils were 14 mm below the foramen magnum). An MRI scan of the cervical spine did not reveal a syrinx. The patient was evaluated by the neurosurgery department and subsequently underwent a suboccipital decompression procedure, which involved a midline incision with removal of the arch of C1, the midline part of C2, and a small craniectomy. The dura was opened, and the cerebellar tonsils were noted to extend down to C1. The dura was closed with a graft to provide an expanded dural envelope. In the immediate postoperative period, the patient had complaints of persistent pressure sensation in her head, which later resolved. She has done well, with resolution of the disorientation, head fullness, fatigue, and tinnitus (8 months after surgery at the time of this writing). Her headaches are significantly less severe and less frequent. Electronystagmographic testing performed 1½ years after surgery revealed a persistence of a right-beating nystagmus but only with the head turned to the right; the spontaneous nystagmus in all positions had resolved.
Diganosis Radiology Quiz 2. Arch Otolaryngol Head Neck Surg. 2002;128(9):1106-1107. doi: