Spontaneous resolution of Chiari I malformation and syringomyelia: Case report and review of the literature

OBJECTIVE AND IMPORTANCE: Indications for surgery and the surgical techniqu e of foramen magnum decompression for patients with Chiari 1 malformation a nd syringomyelia are controversial issues. This case report supports the vi ew that observation may be adequate for patients without progressive sympto ms or with mild clinical symptoms. CLINICAL PRESENTATION: A 37-year-old woman presented with a 3-month history of burning dysesthesias and hypesthesia in her right arm. A neurological e xamination revealed hypesthesia in the right trigeminal distribution. A mag netic resonance imaging scan revealed a Chiari 1 malformation with syringom yelia between C2 and T2. No hydrocephalus was observed. CLINICAL COURSE: Because the patient's symptoms regressed spontaneously, su rgery was not performed. Thirty-two months after her initial examination, t he patient was asymptomatic. A second magnetic resonance imaging scan was o btained, which demonstrated complete spontaneous resolution of the Chiari I malformation and syringomyelia. CONCLUSION: We attribute the regression of the patient's symptoms to sponta neous recanalization of cerebrospinal fluid pathways at the foramen magnum, which most likely was due to rupture of the arachnoid membranes that had o bstructed cerebrospinal fluid flow.