A case report: resolution of Chiari I malformation after helmet therapy for deformational brachycephaly
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CASE REPORT
A case report: resolution of Chiari I malformation after helmet therapy for deformational brachycephaly Mary E. Street 1 & Arshad R. Muzaffar 2 & Tomoko Tanaka 3,4 Received: 29 April 2020 / Accepted: 28 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Positional plagiocephaly is the most common cause of cranial asymmetry. Deformational brachycephaly denotes a head shape characterized by occipital flattening and increased bilateral width, which can also be caused by external deformation of the moldable infant cranium in positional bilateral posterior plagiocephaly. There are reports of craniosynostosis associated with Chiari I malformation (CIM), possibly caused by decreased posterior fossa volume and related to increased intracranial pressure. To the best of our knowledge, this is only the second case report demonstrating acquired CIM in a child with positional brachycephaly. Of note, the fact that the CIM resolved after helmet therapy could support the hypothesis that CIM is associated with decreased volume of the posterior fossa. However, these two conditions may be independent of one another. More research is needed to identify an association between the two conditions. Keywords Deformation brachycephaly . Chiari I malformation . Helmet . STARscanner
Introduction Brachycephaly is defined as occipital flattening and increased bilateral width leading to a cranium that is shorter than normal for the species. It can be caused by craniosynostosis and, more commonly, by positional posterior plagiocephaly from repetitive prolonged supine positioning in infants [5]. Both causes of brachycephaly can lead to decreased posterior fossa volume. The prevalence of deformational brachycephaly has been on the rise in the past decades due to the back-to-sleep campaigns to prevent sudden infant death syndrome (SIDS). [12] Often, the brachycephaly requires helmet therapy to correct [6].
Brachycephaly from craniosynostosis is known to cause hindbrain herniation (CIM), especially with multiple suture craniosynostosis and lambdoid craniosynostosis [13]. Anecdotally, there have been experiences of severe cases of deformational brachycephaly associated with CIM. To date, only one case has been reported of a young child with positional brachycephaly and Chiari I malformation [11]. This has led physicians to question if there is a correlation between the volume of the skull base and the anatomical positioning of the hindbrain. Thus, it is crucial to determine if there is a relationship between positional brachycephaly and CIM and what other factors may contribute to positional brachycephaly.
Case presentation * Tomoko Tanaka [email protected] 1
University of Missouri, School of Medicine, One Hospital Dr, Columbia, MO 65212, USA
2
Division of Plastic Surgery, University of School of Medicine, One Hospital Dr, Columbia, MO 65212, USA
3
Department of Neurosurgery, University of Arkansas for Medical Sciences, 4301 W Markham St. #503, Little Rock, AR 72205, USA
4
Division of Pediatric
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