The use of the trendelenburg position in the surgical treatment of extreme cerebellar slump

Abstract

Background. State-of-the-art treatment for Chiari Malformation I (CM-I) consists of decompression by posterior fossa craniectomy. A rare but severe complication that develops over months to years after this procedure is cerebellar slump. Treatment options for this condition are limited. We present a new and promising approach to treat this rare condition. Methods. The patients were placed in the Trendelenburg position to facilitate ascent of the cerebellum. After almost complete dissolution of neurologic symptoms, surgical reconstruction was performed by tonsillar resection and the creation of a new structural support using a bone graft. Results. Both patients experienced good clinical and morphological outcomes immediately after surgery, and for two years thereafter. Conclusions. Neurological symptoms related to cerebellar or brainstem slump can be adequately reversed by placing the patient in the Trendelenburg position. After uneventful gravitational reversal of the slump, safe surgical reconstruction of the cerebellar support can be performed to securely preserve the anatomical reversal.

Keywords::

• brainstem
• cerebellar
• slump
• Trendelenburg

Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.