TREATMENT OF CHIARI III MALFORMATION IN INFANT WITH 4K 3D ORBEYE EXOSCOPE.

Chiari III malformation (CM-III) is the rarest anomaly among CMs1 . Treatment of choice is surgical repair2 , although poor outcome and postoperative mortality has been reported3 . Surgical timing is still debated4,5 . We present the case of a male infant with a prenatal diagnosis of encephalocele. Presentation was characterized by hemodynamic instability, horizontal nystagmus, and left shoulder dystocia due to caesarean section, with a 64x49x76 mm soft, fluctuant, and translucent suboccipital-cervical sac. MR revealed a median occipital bone defect with the meningoencephalic sac communicating with the vermian cistern and the fourth ventricle; moderate hydrocephalus, reduction of the posterior cranial fossa volume, hypoplasia of cerebellar hemispheric, vermian structures and corpus callosum hypoplasia. The patient underwent surgery on day-4 with the use of 4K 3D ORBEYE™ exoscope. Surgery consisted in disengagement of nervous structures and repair of the neurocutaneous defect, followed on day-12 by VP shunt with programmable valve. The procedures were well tolerated. At 14-months follow-up visit he was in range with Growth charts (weight, height and cranic circumference) and gained the physiological stages of growth, no motor impairment, still present convergent strabismus, mild left C5-C6 radiculopathy, secondary to shoulder dystocia. This is the first case reported in the literature of CM-III treated with the 4K 3D exoscope. Advantages of exoscope were ergonomic positions for operative staff, possibility for the team to assist in 4K 3D view, especially in cases with a narrow operative field, with a clear and detailed vision, although learning curve is required6 becoming a valid alternative in paediatric neurosurgery.