Treatment Options for Chiari Malformation: Surgery and Non-Surgical Approaches

November 22nd, 2024 by New Jersey Brain and Spine

Chiari malformations are a group of complex brain abnormalities that affect the area in lower posterior skull where the brain and spinal cord connect. The most common form is the Chiari Type 1 malformation, which we will focus on in this article..

What Causes a Chiari malformation?

The exact cause of Chiari malformations are unknown. Sometimes the condition is present from birth, but the most common form (Type 1) is normally found in adulthood after symptoms develop.

Doctors categorize Chiari malformations into four types (Type I, Type II and Type III and Type IV), depending on the anatomy of the brain tissue that is displaced into the spinal canal.

A Chiari malformation may occur when part of the skull is abnormally small or misshapen, putting pressure on the brain and forcing it downward. This causes brain tissue in the lower portion of the skull to extend into the spinal canal. The additional pressure placed on the brain stem and spinal cord can block the flow of cerebrospinal fluid from the brain to the spine. It is believed that trauma to the neck or head, such as whiplash, may cause pre-existing Chiari malformations to turn symptomatic.

What are Symptoms Associated with a Chiari Malformation?

Many people with Chiari malformation have no initial signs or symptoms, and the condition is only detected when testing is performed for unrelated disorders. Many patients will never have symptoms at all. However, depending on the severity of the condition Chiari malformations can cause a number of symptoms, such as:

Neck pain
Unsteady gait
Poor hand coordination
Numbness of hands and feet
Dizziness
Difficulty swallowing
Balance problems
Speech problems or Hoarseness

Diagnosis of Chiari Malformations

There are several tests that can help to diagnose and determine the extent of Chiari malformation. These may include MRIs and CT scans. Treatment options will depend upon the form of the condition, its severity, its progression and mainly if there are associated symptoms.

Surgical and Non-surgical Treatment Options of Chiari 1 Malformations

Treatment is always guided by the severity of symptoms from the Chiari 1 malformation. Patients with this condition should talk with their doctor about what treatments are best for their particular case. Chiari malformations that are not showing significant symptoms and do not interfere with daily living may only need regular monitoring via diagnostic imaging. Medications may also be prescribed to ease headaches and mild neck pain. However, there are no other known effective non-surgical treatments for stopping the progression of Chiari malformation over time.

In many cases, if symptoms are severe enough, surgery is the only available treatment to halt progression of the condition and reduce damage to the central nervous system. Surgery will improve or stabilize symptoms in most cases.

The most common surgery to treat Chiari malformation is a posterior fossa decompression, which creates more space for the cerebellum and reduces pressure on the spinal cord. The technical name for the procedure is a suboccipital craniectomy. This is a routine procedure that involves making an incision on the back of the head and removing a small portion of bone at the bottom of the skull (a procedure called a craniectomy). In some cases, a procedure known as a laminectomy may also be performed when necessary.

If you would like more information on treating a Chiari malformation, please schedule an appointment with one of our experienced neurosurgeons. Our physicians are skilled in performing highly complex treatments for a wide-range of conditions.

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