Chiari Malformation

Chiari malformation is a condition in which the brain tissues extend or herniates into the spinal canal. It can happen when the posterior fossa (a space in the skull that has cerebellum, a part of brain) is smaller than usual pressing the brain downwards.   

They are categorized into four categories- Type 1, Type 2, Type 3 and Type 4. Type 1 Chiari malformation develops as the skull and brain develop while Type 2,3 and 4 Chiari malformations are congenial, present by birth.   

Chiari Malformation symptoms

Depending on the type and severity of the condition, Arnold Chiari malformation can cause many like– 

Causes of Chiari malformations   

Chiari malformations are caused by structural defects in the brain and the spinal cord during the developmental period. The lower parts of the cerebellum known as the tonsils get displaced into the upper spinal canal. It leads to interference of the normal flow of cerebrospinal fluid (CSF) that protects the brain and the spinal cord resulting in the blockage of the fluid pathway transmitted from the skull into the spinal canal.

Chiari malformation type 2 is basically associated with a form of spina bifida called myelomeningocele. 

Diagnosis of Chiari malformation

Magnetic Resonance Imaging (MRI)

This three-dimensional imaging technology provides accurate scans of the brain, cerebellum, and spinal cord helping in the deep examination of the extent of malformation. It also helps to evaluate fluid blockage using CSF flow studies.

Computed tomography scan (CT scan)-

It is very useful for evaluating bone abnormalities at the skull base and the cervical canal. 

Sleep study or polysomnography- It

It is usually ordered when the patient has sleep apnea or excessive snoring during sleep. in which they monitor the breathing pattern, snoring, blood oxygenation levels, and seizure activity during the sleep.

Swallowing study

Fluoroscopy is used to examine the internal swallowing process to determine any abnormality in swallowing that can result from lower brainstem dysfunction.

Treatment of Chiari malformations  

Treatment of this condition depends on the type, severity, and symptoms associated with it. Medications are advised to manage symptoms such as pain.

Most of the patients need only symptomatic treatment as the Chiari malformation is usually small and does not lead to obstruction of the CSF flow. When there are severe symptoms or development of spinal cord syrinx due to obstruction of CSF flow, it needs Chiari malformation surgery. 

Foramen Magnum Decompression Surgery

This spine surgery  involves the removal of a small portion of the bottom of the skull and spinal column in order to decompress the tonsils of the cerebellum.   

If you have been advised surgery, then get a second opinion from another surgeon for Chiari malformation to know whether it is right for you.  

Dr. Arun Rajeswaran

Consult Dr. Arun with a professional experience of more than 13 years in the field of Neurosurgery

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