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Chiari Malformation

Chiari Malformation refers to malformation of the skull which is often congenital (present from birth). This malformation produces a compartment that is smaller than normal for the brain stem and cerebellum (back of the brain). As a result pressure is put upon the structures. Occasionally Chiari Malformation is associated with other congenital abnormalities such as Spina Bifida, kidney abnormalities, or other brain abnormalities. Chiari usually does not affect an individual’s intelligence.

There are many asymptomatic patients whose MRI scans show radiographic evidence of a Chiari Malformation. These individuals often never require treatment. Symptomatic patients sometimes experience severe headaches, which can be associated with coughing or straining. If the compression of the brain and brain stem significantly increases there can be pain, numbness, and weakness of the arms and sometimes the legs. There can also be walking and balance problems. Sometimes a large cyst develops within the spinal cord because of the compression. Various imaging techniques, and special MRI studies (CSF Flow Studies) are essential in diagnosing possible Chiari Malformations.

Once diagnosed conservative therapies for Chiari include behavior modification (avoid high stress activities and high impact sports) and various medications to control headaches.

Chiari Decompression
If conservative therapy fails, and the pain is unbearable or the patient has progressive neurologic deficits, then surgical decompression is warranted. This involves an incision in the back of the neck with a removal of the bone from the base of the skull and the upper two vertebras. The leather like covering of the spinal cord (dura) is then cut and a special patch is then sewn in covering the brain and spinal cord to give ample room to these structures. This allows for free flow of the spinal fluid and releases the pressure on the spinal cord caused by the chiari malformation and leads to improvement in the patient's symptoms. These surgeries take approximately 3 hours and do not involve a fusion procedure. Patients usually remain in the hospital for 3-5 days after surgery. The outcomes of surgery strongly depend on correctly diagnosing the problem with positive X-ray findings, and choosing the appropriate patient for surgery.

 

 

 

not intended as a substitute for medical advise.  Always consult your physician about your medical condidion.
Last modified: March 7th, 2011