PMC4208407_01
Polysomnogram demonstrates repetitive central apneas during two 120-s epochs during N2 (top) and REM (bottom) sleep.
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F1
Polysomnography revealed an apnea-hypopnea index (AHI) of 155/hour, with central apnea index (CAI) of 142/h (Figure 1; Table 1), mean oxyhemoglobin saturation of 94%, and an arousal index (AI) of 75/h.
Adaptive servoventilation (ASV) completely resolved central disordered breathing events and snoring and improved sleep consolidation.
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F2
SDB events and snoring, improving sleep consolidation with AI being reduced to 18.6/h (Figure 2). She was treated with ASV therapy throughout the remainder of her pregnancy and gave birth to a healthy baby girl at term by normal spontaneous vaginal delivery.
Sagittal T2-weighted MRI scans of the cervical spine demonstrate significant posterior fossa volume reduction (circle) with basilar invagination (red arrow) and a Chiari 1 malformation with 2.2-cm cerebellar tonsillar protrusion below the foramen magnum (circle), resulting in pontomedullary compression and a 1.2-cm maximal diameter cervical cord syrinx (pink arrow, top). Following suboccipital craniectomy and C1-2 laminectomy with duraplasty surgery, the post-operative scans show an increased posterior fossa volume (circle) with adequate decompression of the brainstem and cervical syrinx to a maximal diameter of 12 mm (pink arrow, bottom).
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F3
Hydrocephalus was not observed (Figure 3). Repeated MRI showed substantially increased volume in the posterior fossa, with improvement in the extent and maximal diameter of the cervical syrinx cavity (Figure 3).