Transosseous cerebrospinal fluid fistula 14 years after Chiari decompression: presentation and management

The authors report a unique case of a transosseous CSF fistula that was detected more than 10 years after treatment of a symptomatic Chiari I malformation. This lesion initially presented as an intraosseous cystic lesion involving the C-2 vertebra, which was found to communicate freely with the subarachnoid space through a tiny dural opening. Surgical management involved hemilaminectomy and repair of the dural defect followed by reinforcement of the bony defect with demineralized bone matrix. Following closure of the fistula, symptoms of elevated intracranial pressure developed, necessitating a ventriculoperitoneal shunt for CSF diversion.