Bilateral Vocal Cord Abduction Paralysis after C1 Laminectomy in a Child with Type 1 Arnold Chiari Malformation.

IF 3.7 2区 医学 Q1 REHABILITATION
Aliyar Zahedi Vafa, Stéphane Hans, Mohamad Khalife, Jérôme R Lechien
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Abstract

Background: Type 1 Arnold Chiari is a neurological malformation that may be associated with vocal cord paralysis in Children. In most cases, the vocal cord paralysis is related to protrusion of medulla and cerebellum in the foramen magnum, which led to compression on the vagus nerve.Case report: A 12-year-old child underwent suboccipital decompression and C1 laminectomy for a symptomatic type 1 Arnold Chiari malformation. After the surgery, patient reported severe dyspnea, aphonia, and dysphagia. The videolaryngostroboscopy and neurological examinations reported a postoperative bilateral vocal cord abduction paralysis due to bilateral IX and X cranial nerve paralyzes and a bilateral paralysis of the tongue.Discussion: The type 1 Arnold Chiari malformation clinical picture may present with unilateral or bilateral vocal cord paralysis, which may resolve with an adequate management of the disease. However, the neurosurgical decompression and C1 laminectomy may result in bilateral lesion of the IX, X, and XII cranial nerves, and related severe swallowing, aspiration and vocal cord disorders.Conclusion: We reported the first case of bilateral vocal cord abduction paralysis occurring post-neurosurgical decompression and C1 laminectomy in a child with type 1 Arnold Chiari malformation. This case highlights the importance of surgical steps of the procedure in front of the C1 vertebrae where there are IX, X, and XII cranial nerves.

1型Arnold Chiari畸形患儿C1椎板切除术后双侧声带外展麻痹1例。
背景:1型Arnold Chiari是一种可能与儿童声带麻痹相关的神经系统畸形。多数情况下,声带麻痹与髓质和小脑在枕骨大孔内的突出有关,从而压迫迷走神经。病例报告:一名12岁儿童因症状性1型Arnold Chiari畸形接受枕下减压和C1椎板切除术。术后患者出现严重的呼吸困难、失音和吞咽困难。视频喉频镜检查和神经学检查报告了术后双侧声带外展麻痹,原因是双侧IX和X颅神经麻痹和双侧舌头麻痹。讨论:1型Arnold Chiari畸形的临床表现可能表现为单侧或双侧声带麻痹,这可能通过适当的疾病管理来解决。然而,神经外科减压和C1椎板切除术可能导致双侧IX、X和XII脑神经损伤,并伴有严重的吞咽、误吸和声带疾病。结论:我们报告了一例1型Arnold Chiari畸形患儿在神经外科减压和C1椎板切除术后出现双侧声带外展麻痹的病例。该病例强调了在C1椎骨前进行手术步骤的重要性,因为C1椎骨前有IX、X和XII脑神经。
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来源期刊
CiteScore
6.20
自引率
4.70%
发文量
495
审稿时长
38 days
期刊介绍: The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields. This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities. Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal.
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