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.
Depending on the type and severity of the condition, Arnold Chiari malformation can cause many like–
Chiari malformation type 2 is basically associated with a form of spina bifida called myelomeningocele.
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.
It is very useful for evaluating bone abnormalities at the skull base and the cervical canal.
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.
Fluoroscopy is used to examine the internal swallowing process to determine any abnormality in swallowing that can result from lower brainstem dysfunction.
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.
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.
Chiari malformation typically causes severe headaches at the back of the head (triggered by coughing or straining), neck pain, dizziness, difficulty swallowing, hand numbness, and balance problems. It is diagnosed with an MRI scan of the brain and cervical spine which shows downward displacement of the cerebellar tonsils.
Not all patients with Chiari malformation require surgeryasymptomatic cases are often monitored. When symptoms are significant or progressive, posterior fossa decompression surgery is performed. This involves removing a small portion of bone at the base of the skull to enlarge the space and relieve pressure on the brain and spinal cord.
Most patients experience significant improvement in headaches and neurological symptoms after decompression surgery. Hospital stay is typically 3–5 days, and initial recovery takes 4–6 weeks. Full recovery including return to physical activities may take 3–6 months, depending on symptom duration before surgery and individual healing.
Department of Neurosurgery - Zulekha Hospital, First Floor - Block B - 204th Rd, Al Nahda - Al Nahda 2 - Dubai
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