Fourth ventricle stent placement for treatment of type I Chiari malformation in children

Introduction: Type I Chiari malformation (CM-I) is a common congenital malformation, often accompanied by syringomyelia. Obstruction of CSF circulation in the foramen magnum is the reason for the formation of the syringomyelia. A fourth ventricle stent (FVS) could ensure the CSF flow from the fourth ventricle, which might represent an effective approach to achieve syringomyelia relief. Methods: : We have reviewed four cases of CM-I children who received FVS implantation from November 2021 to July 2022. Each of the patients underwent FMD. The ventricular catheter of an Ommaya reservoir (Medtronic, Inc.) was used as a stent. Duraplasty was performed with autologous fascia. Cervical MRI rechecks were routinely done three months later, and the clinical symptoms were followed up. Results: : Four children received FVS, including one boy and three girls, aged from 12 months to 10 years, with a mean age of 6.8 years. No major complication occurred. The syringomyelia or hydrocephalus in each patient were all attenuated, as observed on the reexamination MRI images. During the follow-up time with a mean of 10.8 months, no patient had new symptoms. Conclusion: FVS is an effective and safe method for operation of CM-1 in children. The indications of FVS include redo-FMD, with obstructive hydrocephalus and difficulties to ensure post-FMD CSF circulation patency at the foramen magnum.