Chiari Malformation
Medical experts divide Chiari malformation into several types, in part to reflect the degree of displacement of the brain tissue into the spinal canal. The most common are Chiari-I and Chiari-II.
Symptoms
No symptoms; severe head and neck pain, headaches accentuated by coughing, sneezing or straining; dizziness, vertigo, disequilibrium, muscle weakness or balance problems; blurred or double vision, difficulty in tracking objects or a hypersensitivity to bright lights; tinnitus (buzzing or ringing in the ear), hearing loss or vocal cord paralysis; difficulty swallowing, frequent gagging and choking; sleep apnea.
About this Condition
Medical experts divide Chiari malformation into several types, in part to reflect the degree of displacement of the brain tissue into the spinal canal. The most common are Chiari-I and Chiari-II.
In Chiari-I malformation, brain tissue protrudes below the opening of the base of the skull. Symptoms usually begin early in adulthood. The malformation may be associated with syringomyelia (a tubular, fluid-filled cavity within the spinal cord) and abnormalities in the bones of the skull, spine or both. The cavity is known as a syrinx. Patients diagnosed with a Chiari malformation should have the spine imaged to rule out the presence of a syrinx, since it may be a consideration in treatment and prognosis.
Chiari-II malformation involves a greater degree of brain tissue protruding into the spinal canal. Chiari-II malformation is almost always associated with myelomeningocele (a type of spina bifida) and hydrocephalus (excess fluid buildup within the brain), which usually are apparent at birth.
The most definitive test used to diagnose Chiari malformation is magnetic resonance imaging (MRI) of the head. Physicians can accurately view the cerebellum and surrounding structures and determine what form and to what extent the malformation has progressed.
This content is for your general education only. See your doctor for a professional diagnosis and to discuss an appropriate treatment plan.
Conservative Treatments
Monitoring a Chiari Malformation
If you have no symptoms, your doctor likely will recommend no treatment other than monitoring with regular examinations.
Medications for a Chiari Malformation
When head or neck pain is the primary symptom, your doctor may recommend pain medication. Some people experience symptom relief with anti-inflammatory or pain-relieving agents such as ibuprofen. This approach may prevent or delay the need for an operation.
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Surgery
Chiari Decompression
Surgery is the approach doctors use most often to treat symptomatic Chiari malformations. The goal is to stop the progression of changes in the anatomy of the brain and spinal canal, as well as ease or stabilize symptoms. When successful, surgery can reduce pressure on the cerebellum and the spinal cord, and restore the normal flow of spinal fluid.
In the most common operation for Chiari malformation—called posterior fossa craniectomy or posterior fossa decompression—your surgeon removes a small section of bone in the back of the skull, relieving pressure by giving the brain more room. The covering of the brain, called the dura, is then opened, and a patch is sewn in place to enlarge the covering and provide more room for the brain; this patch may be an artificial material, or it could be tissue harvested from your own inner scalp. The exact technique may vary, depending on whether a fluid-filled cavity is present, or if you have hydrocephalus.
The operation is successful in most people, but if nerve injury in the spinal canal has already occurred prior to surgery, this procedure may not reverse the damage.
Please keep in mind that all treatments and outcomes are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results and other important medical information.