If you have been diagnosed with Chiari malformation, one of the first questions you may have is, “Can Chiari malformation get worse?” The simple answer is, yes, it can, which is why many (though not all) patients will require treatment. If you are already experiencing symptoms and/or your doctor has reason to believe your symptoms will progress, he or she will likely recommend treatment.
Whether you are still in the treatment planning phase or already have your procedure scheduled, it can be helpful to understand more about your condition and the treatment options available. Educating yourself is a great way to play a more active role throughout the treatment process, helping foster confidence and peace of mind along the way.
An Overview of Chiari Malformation
Can Chiari malformation get worse? Yes, it is possible, and a little background information can help you understand why. Before birth, your brain and skull develop together, forming together in a way that maximizes protection and function. Within the skull are grooves and openings for different areas of the brain. In a Chiari malformation, the groove that holds the cerebellum (an area at the back of the brain) does not grow large enough. As a result, the softer brain gets displaced through an opening in the bony skull, the foramen magnum.
The foramen magnum is an important structure on its own. It is where the brainstem and spinal cord leave the skull, which are surrounded by a fluid called cerebrospinal fluid (CSF). However, when a Chiari malformation is present, the cerebellum is pushed through the foramen magnum, creating a blockage and/or putting pressure on the brain stem or spinal cord. A buildup of fluid in the spinal cord can develop and progress, leading to increased damage to vital structures. Furthermore, changes in the surrounding tissues that occur with normal ageing can result in reduced flexibility and worsened symptoms
Treating Chiari Malformation
Generally speaking, when non-surgical treatment options for Chiari malformation have failed, there are two surgical approaches to treating Chiari malformation: traditional treatments and minimally invasive treatments. Your personal doctor will make treatment recommendations based on your individual condition and health factors. However, having a broad understanding of all the treatment options available can help you in your conversations with your doctor and as you educate yourself, as you are doing right now.
Traditional Treatment Options
Traditional Chiari malformation treatment options use a standard surgical approach to help create space and alleviate pressure, restoring the flow of CSF and/or removing impingement on the brain stem or spinal cord. These include dural opening Chiari decompression surgery, cervical laminectomy and CSF diversion. Your doctor may recommend one surgery or a combination approach.
Dural Opening Chiari Decompression
During dural opening Chiari decompression, the neurosurgeon will remove a small section of bone at the base of the skull and open up the dura, the delicate membrane that covers the brain. The surgeon will place a patch, which creates more space for the dura to stretch, creating more room for the cerebellum and alleviating pressure. The site is closed using sutures or staples and allowed to heal.
Another traditional procedure is called a cervical laminectomy. During this procedure, the surgeon removes a small section of your uppermost vertebrae to create space for the spinal cord. This is often done in conjunction with dural opening Chiari decompression but may be performed alone.
Cerebrospinal Fluid (CSF) Diversion
Another traditional treatment option, that is rarely performed, is CSF diversion. This procedure remove excess CSF that has built up, diverting it to another area where the body can absorb it, such as the abdomen. The surgeon places a shunt at the area of the buildup, which bypasses the area of blockade by redirecting the CSF to be absorbed into the bloodstream.
Minimally Invasive Treatment Options
As with the above traditional options, minimally invasive Chiari malformation treatment options also attempt to relieve pressure by creating space. In fact, many patients who are candidates for traditional options can also be treated using a minimally invasive approach.
Minimally Invasive Chiari Decompression
The first treatment is minimally invasive Chiari decompression. In this procedure, the surgeon uses microscopic tools and visualization to access the bone at the base of the skull and first vertebrae, using a smaller incision and eliminating the need for a patch. Patients tend to experience less pain and a shorter recovery time following minimally invasive Chiari decompression as compared to traditional dural opening Chiari decompression.
Non-Dural Opening Posterior Fossa Decompression
A second procedure is non-dural opening posterior fossa decompression, a similar procedure that also involves removing a small piece of bone to create more space. Again, the neurosurgeon uses specialized tools to create a smaller incision, resulting in less trauma to surrounding tissues and a less invasive procedure overall.
The Right Treatment Path for You
Now that you have a more thorough understanding of your Chiari malformation and the available treatment options, you can continue the discussion with your Chiari specialist as it relates to your individual condition. At this point, you can appreciate the importance of building a relationship with your doctor so he or can answer your questions and address any concerns you may have.
While not every patient with Chiari malformation will require treatment, you can see that the answer to your original question, “Can Chiari malformation get worse?” is that it has the potential to, depending on the individual. By working with an expert who understands the condition, its progression and how to develop an appropriate treatment plan, you can rest assured that you are on the right path.