{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T23:46:22Z","timestamp":1776815182952,"version":"3.51.2"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:p>The authors present a case of Chiari type 1.5 malformation with the uncommon presenting symptoms of esotropia and diplopia due to divergence insufficiency in a 12-year-old girl. Imaging at initial diagnosis revealed cerebellar herniation with extension of the tonsils to the C2 vertebral body, a retroflexed odontoid, and a small cervical syrinx. The patient was initially treated with an uncomplicated Chiari malformation decompression without dural opening. Repeat imaging revealed an adequate decompression. Three months postoperatively the patient\u2019s diplopia recurred and she underwent repeat posterior fossa decompression with dural opening and duraplasty. Following repeat decompression with dural opening and duraplasty, the patient\u2019s diplopia had not recurred by the 2-year follow-up.<\/jats:p><jats:p>https:\/\/thejns.org\/doi\/abs\/10.3171\/2018.5.PEDS1886<\/jats:p>","DOI":"10.3171\/2018.5.peds1886","type":"journal-article","created":{"date-parts":[[2018,8,10]],"date-time":"2018-08-10T13:55:40Z","timestamp":1533909340000},"page":"504-507","source":"Crossref","is-referenced-by-count":4,"title":["Divergence insufficiency alleviated by posterior fossa decompression with duraplasty in a patient with Chiari type 1.5 malformation"],"prefix":"10.3171","volume":"22","author":[{"given":"Allison","family":"Strickland","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma Health Sciences Center; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cordell M.","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma Health Sciences Center; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. Michael","family":"Siatkowski","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy B.","family":"Mapstone","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma Health Sciences Center; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Comput Assist Tomogr","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1097\/00004728-198511000-00005","article-title":"Position of cerebellar tonsils in the normal population and in patients with Chiari malformation: a quantitative approach with MR imaging","volume":"9","author":"Aboulezz AO","year":"1985","unstructured":"Aboulezz AO, Sartor K, Geyer CA, Gado MH: Position of cerebellar tonsils in the normal population and in patients with Chiari malformation: a quantitative approach with MR imaging. J Comput Assist Tomogr 9:1033\u20131036, 1985405613210.1097\/00004728-198511000-00005"},{"key":"b2","series-title":"Am J Ophthalmol","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1016\/S0002-9394(00)00457-8","article-title":"Isolated comitant esotropia and Chiari I malformation","volume":"130","author":"Biousse V","year":"2000","unstructured":"Biousse V, Newman NJ, Petermann SH, Lambert SR: Isolated comitant esotropia and Chiari I malformation. Am J Ophthalmol 130:216\u2013220, 200010.1016\/S0002-9394(00)00457-811004297"},{"key":"b3","series-title":"J Pediatr Ophthalmol Strabismus","first-page":"83","article-title":"Acquired esotropia as initial manifestation of Arnold-Chiari malformation","volume":"24","author":"Bixenman WW","year":"1987","unstructured":"Bixenman WW, Laguna JF: Acquired esotropia as initial manifestation of Arnold-Chiari malformation. J Pediatr Ophthalmol Strabismus 24:83\u201386, 19873585657"},{"key":"b4","series-title":"Surv Ophthalmol","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.survophthal.2005.12.008","article-title":"Skew deviation revisited","volume":"51","author":"Brodsky MC","year":"2006","unstructured":"Brodsky MC, Donahue SP, Vaphiades M, Brandt T: Skew deviation revisited. Surv Ophthalmol 51:105\u2013128, 20061650021210.1016\/j.survophthal.2005.12.008"},{"key":"b5","series-title":"Am J Ophthalmol","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1016\/S0002-9394(02)01354-5","article-title":"Resolution of acute acquired comitant esotropia after suboccipital decompression for Chiari I malformation","volume":"133","author":"Defoort-Dhellemmes S","year":"2002","unstructured":"Defoort-Dhellemmes S, Denion E, Arndt CF, Bouvet-Drumare I, Hache JC, Dhellemmes P: Resolution of acute acquired comitant esotropia after suboccipital decompression for Chiari I malformation. Am J Ophthalmol 133:723\u2013725, 200210.1016\/S0002-9394(02)01354-511992882"},{"key":"b6","series-title":"Curr Opin Ophthalmol","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1097\/ICU.0000000000000105","article-title":"Skew deviation: clinical updates for ophthalmologists","volume":"25","author":"Hernowo A","year":"2014","unstructured":"Hernowo A, Eggenberger E: Skew deviation: clinical updates for ophthalmologists. Curr Opin Ophthalmol 25:485\u2013487, 20142525073410.1097\/ICU.0000000000000105"},{"key":"b7","series-title":"Ophthalmology","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1016\/S0161-6420(00)00439-5","article-title":"Acute comitant esotropia in Chiari 1 malformation","volume":"108","author":"Imes RK","year":"2001","unstructured":"Imes RK, Quinn TA: Acute comitant esotropia in Chiari 1 malformation. Ophthalmology 108:834, 20011132000010.1016\/S0161-6420(00)00439-5"},{"key":"b8","series-title":"Arch Ophthalmol","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1001\/archopht.118.9.1237","article-title":"Divergence insufficiency revisited: natural history of idiopathic cases and neurologic associations","volume":"118","author":"Jacobson DM","year":"2000","unstructured":"Jacobson DM: Divergence insufficiency revisited: natural history of idiopathic cases and neurologic associations. Arch Ophthalmol 118:1237\u20131241, 200010.1001\/archopht.118.9.123710980769"},{"key":"b9","series-title":"Binocul Vis Strabismus Q","first-page":"18","article-title":"Chiari 1 malformation presenting as strabismus","volume":"21","author":"Kowal L","year":"2006","unstructured":"Kowal L, Yahalom C, Shuey NH: Chiari 1 malformation presenting as strabismus. Binocul Vis Strabismus Q 21:18\u201326, 200616457660"},{"key":"b10","series-title":"J Neuroophthalmol","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1097\/00041327-199603000-00012","article-title":"Acquired esotropia due to Arnold-Chiari I malformation","volume":"16","author":"Lewis AR","year":"1996","unstructured":"Lewis AR, Kline LB, Sharpe JA: Acquired esotropia due to Arnold-Chiari I malformation. J Neuroophthalmol 16:49\u201354, 199610.1097\/00041327-199603000-000128963421"},{"key":"b11","series-title":"AMA Arch Surg","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1001\/archsurg.1951.01250040799009","article-title":"Arnold-Chiari malformation","volume":"63","author":"Malis LI","year":"1951","unstructured":"Malis LI, Cohen I, Gross SW: Arnold-Chiari malformation. AMA Arch Surg 63:783\u2013798, 19511486824610.1001\/archsurg.1951.01250040799009"},{"key":"b12","series-title":"Eur J Paediatr Neurol","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.ejpn.2011.04.001","article-title":"Acute VI nerve palsy in a 4 year-old girl with Chiari I malformation and pontomedullary extension of syringomyelia: case report and review of the literature","volume":"15","author":"Massey SL","year":"2011","unstructured":"Massey SL, Buland J, Hauber S, Piatt J Jr, Goraya J, Faerber E, : Acute VI nerve palsy in a 4 year-old girl with Chiari I malformation and pontomedullary extension of syringomyelia: case report and review of the literature. Eur J Paediatr Neurol 15:303\u2013309, 201110.1016\/j.ejpn.2011.04.001"},{"key":"b13","series-title":"J Clin Neuroophthalmol","first-page":"151","article-title":"Acquired esotropia. A manifestation of Chiari I malformation","volume":"4","author":"Passo M","year":"1984","unstructured":"Passo M, Shults WT, Talbot T, Palmer EA: Acquired esotropia. A manifestation of Chiari I malformation. J Clin Neuroophthalmol 4:151\u2013154, 19846238049"},{"key":"b14","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"183","DOI":"10.3171\/jns.1983.58.2.0183","article-title":"Arnold-Chiari malformation. Review of 71 cases","volume":"58","author":"Paul KS","year":"1983","unstructured":"Paul KS, Lye RH, Strang FA, Dutton J: Arnold-Chiari malformation. Review of 71 cases. J Neurosurg 58:183\u2013187, 1983684867410.3171\/jns.1983.58.2.0183"},{"key":"b15","series-title":"Optom Vis Sci","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1097\/OPX.0b013e318157c6c6","article-title":"Bilateral abducens palsies and facial weakness as initial manifestations of a Chiari 1 malformation","volume":"84","author":"Pilon A","year":"2007","unstructured":"Pilon A, Rhee P, Newman T, Messner L: Bilateral abducens palsies and facial weakness as initial manifestations of a Chiari 1 malformation. Optom Vis Sci 84:936\u2013940, 20071804935710.1097\/OPX.0b013e318157c6c6"},{"key":"b16","series-title":"J AAPOS","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1016\/j.jaapos.2004.01.014","article-title":"Progressive cerebellar tonsillar herniation with recurrent divergence insufficiency esotropia","volume":"8","author":"Pokharel D","year":"2004","unstructured":"Pokharel D, Siatkowski RM: Progressive cerebellar tonsillar herniation with recurrent divergence insufficiency esotropia. J AAPOS 8:286\u2013287, 200410.1016\/j.jaapos.2004.01.01415226735"},{"key":"b17","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"416","DOI":"10.3171\/jns.1976.45.4.0416","article-title":"Experience with Arnold-Chiari malformation, 1960 to 1970","volume":"45","author":"Saez RJ","year":"1976","unstructured":"Saez RJ, Onofrio BM, Yanagihara T: Experience with Arnold-Chiari malformation, 1960 to 1970. J Neurosurg 45:416\u2013422, 197610.3171\/jns.1976.45.4.0416956878"},{"key":"b18","series-title":"Brain","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1093\/brain\/104.1.51","article-title":"Arnold-Chiari malformation: improvement in eye movements after surgical treatment","volume":"104","author":"Spooner JW","year":"1981","unstructured":"Spooner JW, Baloh RW: Arnold-Chiari malformation: improvement in eye movements after surgical treatment. Brain 104:51\u201360, 198110.1093\/brain\/104.1.517470844"},{"key":"b19","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1007\/s00381-003-0879-x","article-title":"Clinical features of Chiari I malformations","volume":"20","author":"Steinbok P","year":"2004","unstructured":"Steinbok P: Clinical features of Chiari I malformations. Childs Nerv Syst 20:329\u2013331, 200410.1007\/s00381-003-0879-x"},{"key":"b20","series-title":"Ophthalmology","doi-asserted-by":"publisher","first-page":"2368","DOI":"10.1016\/S0161-6420(99)90541-9","article-title":"Treatment of acute comitant esotropia in Chiari I malformation","volume":"106","author":"Weeks CL","year":"1999","unstructured":"Weeks CL, Hamed LM: Treatment of acute comitant esotropia in Chiari I malformation. Ophthalmology 106:2368\u20132371, 19991059967210.1016\/S0161-6420(99)90541-9"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/22\/5\/article-p504.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/22\/5\/article-p504.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/22\/5\/article-p504.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T13:42:35Z","timestamp":1681566155000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/22\/5\/article-p504.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11]]},"references-count":20,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2018.5.peds1886","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11]]}}}