Cerebellum prolapse is the prolapse of the cerebellum into the spinal canal through an opening in the lower part of the skull. In severe types, it is seen together with other congenital anomalies in children. The medical name for cerebellar prolapse is Chiari malformation. There are types 1, 2, 3 and 4 different types.
Is prolapse of the cerebellum life threatening? The mildest types of cerebellum prolapse can be followed without surgery. If the patient has no signs or symptoms, no treatment is required.
The most important side effect of cerebellum prolapse is the development of cysts in the spinal cord. These patients may experience weakness in their legs, wasting in their hand muscles, and loss of strength. This occurs in two-thirds of patients.
Cerebellum prolapsed Chiari Malformation Type 1 is unaware that many people have such an anomaly. Most of these patients have no complaints. People who have no signs and symptoms do not need treatment. It is seen at a rate of one in a thousand in MRI examinations.
Neck pain, headache, balance problems, weakness, dizziness, double vision, swallowing difficulties, walking difficulty, sleep apnea, snoring can be seen. It is frequently seen in spinal curvatures. Shoulder and neck pain, tinnitus are frequently reported. Even irregular heartbeats have been reported.
The clinical picture is mostly seen in childhood, adolescence. However, its incidence in adults is also quite high.
Cerebellum prolapse Chiari Malformation is a prolapse of the cerebellum into the spinal canal. In a narrow area, the brain stem and spinal cord are compressed. In addition, cerebrospinal fluid circulation is impaired. This causes cyst formation in the spinal cord – syringomyelia. If the cyst – syringomyelia – is in the neck spinal cord, the hand muscles are melted.
In case of cyst – syringomyelia – in the spinal cord, investigation should be done in terms of cerebellum prolapse.
How is the diagnosis of cerebellum prolapsed?
In addition to the person’s complaints and examination findings, investigations should be performed. Magnetic resonance brain and neck examination is the first step in diagnosing cerebellum prolapse, Chiari Malformation and cyst within the spinal cord – syringomyelia. It is very important to examine the cerebrospinal fluid flow and dynamics. Cerebrospinal fluid flow and CSF dynamics are examined with CSF FLOW MR – CINE MR. In addition, it is necessary to investigate whether there is an anomaly of the craniovertebral junction. For this, craniovertebral junction direct radiographs and computed tomography should be examined. Scoliosis graphies should also be performed in terms of deformities that may develop in the spine.
Cerebellum prolapse diagnosis and CSF flow MRI examination!
Cine MRI or CSF flow MRI has systolic and diastolic dynamics of cerebrospinal fluid. In cases with Chiari malformation and severe stenosis of the foramen magnum, this dynamic is disrupted and the cerebrospinal fluid passes at a high speed called “Jet flow” where it can pass. After surgery, normal flow begins around the brain stem.
Cerebellum prolapse Treatment?
There is a treatment for cerebellum prolapse. In cases that need to be treated, surgery is the only solution. The aim of the surgery is to reduce the pressure of the hanging cerebellum on the spinal cord. Patients may require more than one surgery.
In surgery, bone structures that will relieve the spinal cord and brain stem should be removed and the cerebellum and spinal cord should be opened. Sometimes it may be sufficient to remove only the bone structures. The name of the operation is foramen magnum decompression. Foramen magnum is the name of the opening of the skull that opens into the spinal canal. The posterior part of this opening of the skull and the posterior part of the first vertebra are surgically removed and this area is expanded. In the next process of the surgery, the cerebellum and spinal cord membranes are opened. It may be sufficient to open the outer membrane stop. However, if it is seen that cerebrospinal fluid circulation cannot be achieved, the inner membrane can be opened in the arachnoid. In some cases, even the drooping cerebellum, which is thought to be dysfunctional, can be removed. In the last part of the surgery, it is to close the cerebellum-spinal cord membrane-dura in a way to widen the canal with a patch taken from the body or synthetically.
The aim of the surgery is to prevent neurological deterioration and cerebrospinal fluid circulation disorder due to brainstem and spinal cord compression due to prolapse of the cerebellum. The name of the operation is foramen magnum decompression and “cisterna magna remodelling”.
After the operation, the hospital is discharged between 2-3 days. The vast majority of patients benefit from this surgery. However, residual signs and symptoms of intraspinal cysts persist in a group of patients. Generally, within 1-2 years, the cerebrospinal fluid begins to normalize, especially within the spinal cord. We can understand this with CSF CURRENT MR – Cine MR.
