Cerebellar Abscess Following Craniocervical Junction Decompression for Chiari I Malformation in a Patient with Rheumatoid Arthritis: A Case Report

‘Chiari Malformations’ are a group of pathologies involving the Craniocervical junction. The most common is Chiari I malformation (CIM), which is characterised by a downward dislocation of the cerebellar tonsils through the foramen magnum. Symptomatic patients and those with syringomyelia are candidates for decompression of the Craniocervical junction. A variety of complications have been described in the literature following this procedure. We present the case of a cerebellar abscess following Craniocervical junction decompression for CIM in a patient with rheumatoid arthritis (RA), which, in our knowledge, is the first described in the literature. We believe that RA and its treatment were major contributors to this complication, mainly due to the immune impairment and the subtle infectious clinical manifestations that they cause. This case led us to modify the perioperative management of patients with RA who undergo spinal surgery in our department. We suggest that strict infection prevention measures should be taken by spine surgeons who treat patients with RA and a high suspicion index for infection should be maintained.