Novan Krisno Adji
Department of Neurology, Soebandi Regional Hospital, Jember, Indonesia

Ulfa Elfiah
Department of Neurology, Soebandi Regional Hospital, Jember, Indonesia

Muhammad Yuda Nugraha
Department of Plastic Surgery, Soebandi Regional Hospital, Jember, Indonesia

DOI: https://doi.org/10.19184/ams.v11i3.53709

Keyword: Case report, hiari malformation, syringomyelia

Abstract

The updated classification of Chiari malformation includes Chiari 1.5 malformation, which explicitly denotes the tonsillar herniation characteristic of Chiari 1 malformation, accompanied by an extended brainstem and a dilated fourth ventricle. We present a Chiari 1 malformation characterized by significant downward herniation of the tonsils and the development of syringomyelia, with no indication of elongation of the fourth ventricle. This example represents an extension of Chiari 1 malformation, which is currently not classified as Chiari 1.5 malformation. A 27-year-old female exhibited cephalic and cervical discomfort for two years. The initial MRI indicated a fall of the cerebellar tonsil beneath the foramen magnum. The midsagittal MRI assessed the degree of tonsillar herniation beneath the foramen magnum. Tonsillar herniation was observed at the C2 level; a spinal MRI revealed syringomyelia affecting the C2 to C3 levels. The patient received a suboccipital craniectomy and C1-C2 laminectomy. There was dural sac pulsation at the C2 level. The patient's cervical discomfort resolved entirely following the surgical procedure. This case represents an extension of Chiari 1 malformation, which is currently not classified as adenotes explicitly 1.5 malformation.