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Acquired Chiari I malformation following baclofen pump placement in a child. Case report
R Shane Tubbs1, Charles Law, W Jerry Oakes
1Department of Pediatrics, University of Alabama at Birmingham, Children's Hospital, Birmingham, Alabama 35233, USA. richard.tubbs@ccc.uab.edu
Insights
A child developed Chiari I malformation after baclofen pump placement for hydrocephalus. This rare complication, acquired Chiari I malformation, resolved with posterior fossa decompression.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Medical Imaging
Background:
- A pediatric patient with hydrocephalus and spastic quadriplegia received an intrathecal baclofen pump.
- Pre-operative imaging showed no evidence of hindbrain herniation.
Observation:
- Post-operatively, the patient developed symptoms suggestive of brainstem compression.
- Magnetic resonance (MR) imaging revealed a significant Chiari I malformation.
Findings:
- The Chiari I malformation was acquired following baclofen pump implantation.
- The ventriculoperitoneal shunt remained fully functional.
- Surgical decompression of the posterior fossa led to symptom resolution.
Implications:
- This case represents the first reported instance of an acquired Chiari I malformation associated with baclofen pump placement.
- Clinicians should be aware of Chiari I malformation as a potential, albeit rare, complication of baclofen pump surgery.
- Prompt diagnosis and surgical intervention are crucial for managing this complication.
Abstract:
The authors present a case of a child suffering from shunt-treated hydrocephalus and spastic quadriplegia who underwent surgery for placement of a baclofen pump. Magnetic resonance (MR) imaging performed prior to pump placement demonstrated no hindbrain herniation. Afterward, however, the patient exhibited symptoms of brainstem compression, and MR imaging revealed a significant Chiari I malformation along with a fully functioning ventriculoperitoneal shunt. Posterior fossa decompression was performed, and the patient's symptoms abated. The authors believe this to be the first report of an acquired Chiari I malformation in a patient with a baclofen pump. Clinicians should consider Chiari I malformation as a rare but severe complication of baclofen pump placement.
