Chiari Malformation

Neurosurgeons of New Jersey is home to a sub-specialized team of neurosurgeons dedicated to the study and treatment of Chiari malformation. Together, we can help determine which treatment option is best for you and your particular goals.

Our Patients’ Guide to Chiari Malformation

About Chiari Malformation

If you look at the inside view of a skull, you will see many grooves and holes that fit the brain perfectly and allow nerves and blood vessels to pass through. The brain and skull develop together, allowing for maximum protection and ideal function.

A Chiari malformation is a problem with one of these grooves, where a part of the brain called the cerebellum fits. The space in the bone is too small to accommodate the cerebellum, a problem that is typically developmental in Type 1 Chiari malformation. As a result, the cerebellum is displaced down through a hole at the bottom of the skull, the foramen magnum.

The foramen magnum is the passageway for the spinal cord, which is cushioned by a liquid called cerebrospinal fluid (CSF). If the passageway is blocked, as it is by the cerebellum in a Chiari malformation, there can be a buildup of CSF, as well as excessive pressure on the brain stem and/or spinal cord.

chiari surgeons looking at scans

Chiari Malformation Quick Facts

  • Not everyone uses the same terminology when describing Chiari. Some people use Arnold-Chiari (ACM) interchangeably with Chiari.
  • Chiari malformation affects people of all races and genders, with women slightly outnumbering men in diagnosis numbers.

Chiari Type 1 Symptoms

Some patients with Chiari malformation will not exhibit symptoms until adulthood, while others may never exhibit any symptoms at all. If symptoms are present, they will typically involve problems arising from direct pressure on the brainstem and/or spinal cord or blockage of cerebrospinal fluid (CSF).

If you suffer from Chiari malformation, you may have experienced:

chiari pain symptoms

Pain Symptoms

- Headaches
- Neck Pain

* Both may worsen when sneezing or coughing.

chiari muscular symptoms

Muscular Symptoms

- Balance Issues / Unsteady Gait
- Difficulty Swallowing
- Muscle Weakness / Numbness
- Difficulty With Fine Motor Skills

chiari sensory symptoms

Sensory Symptoms

- Vertigo
- Tinnitus / Hearing Loss
- Insomnia
- Sleep Apnea
- Blurred / Double Vision

Chiari Malformation Treatments

Many patients with a Chiari malformation are identified incidentally and do not require any treatment. If you experience mild symptoms, these can often be managed non-operatively.

Severely symptomatic Chiari malformation patients may require surgery to resolve the anatomical problem. If your condition is causing symptoms, your physician may recommend surgery to remove the blockage at the foramen magnum and restore the normal flow of CSF. This will stop the disease from getting worse, as well as stabilize or alleviate your symptoms. The particular procedure your surgeon may recommend will depend upon multiple factors, including your age, disease progression and particulars of your case.

Dural Opening Chiari Decompression:

The goal of dural opening Chiari Decompression is to prevent further injury to the spinal cord by making space for the lower regions of the cerebellum outside of the spinal canal while also, hopefully, providing relief from some of the associated symptoms.

Cervical Laminectomy:

When a surgeon performs a cervical laminectomy, he or she is removing the back section of the upper vertebral bone(s) in order to help create space and alleviate pressure around the spinal cord. This procedure is often performed in combination with a Suboccipital Craniectomy in patients with Chiari malformation.

Spinal Fusion:

Spinal fusion is a procedure performed in combination with posterior fossa decompression, for patients who have spinal instability due to coexisting conditions that cause additional issues, such as Ehlers-Danlos syndrome.

Transnasal / Transoral Decompression:

Transnasal / Transoral decompression is a procedure where the surgeon enters through the nose or the mouth, respectively, to remove a section of a vertebra causing compression in patients with Chiari in conjunction with other conditions such as basilar invagination.

Cerebrospinal Fluid (CSF) Diverson:

CSF diversion uses a flexible tube to direct CSF around the blockage, allowing it to flow to another area of the body and be absorbed.

Neuromonitoring:

In conjunction with these procedures, neuromonitoring is performed by trained specialists. Neuromonitoring allows surgeons to identify subtle improvements in nerve pathway functioning in the operating room at critical surgical steps. Neurosurgeons use this during surgery as a safeguard to help prevent complications when operating on delicate structures such as the brain and spinal cord.

Minimally Invasive Chiari Decompression:

This minimally invasive approach, pioneered by our surgeons at Neurosurgeons of New Jersey, achieves the same result as a standard decompression but through a much smaller incision and with added benefits.

Posterior Fossa Decompression:

The surgeon, operating through a small incision with endoscopic or microscopic tools, will remove sections of the occipital bone and/or spine in order to create additional room for the cerebellum.

Neuromonitoring:

In conjunction with these procedures, neuromonitoring is performed by trained specialists. Neuromonitoring allows surgeons to identify subtle improvements in nerve pathway functioning in the operating room at critical surgical steps. Neurosurgeons use this during surgery as a safeguard to help prevent complications when operating on delicate structures such as the brain and spinal cord.

Chiari Malformation Treatments

Many patients with a Chiari malformation are identified incidentally and do not require any treatment. If you experience mild symptoms, these can often be managed non-operatively.

Severely symptomatic Chiari malformation patients may require surgery to resolve the anatomical problem. If your condition is causing symptoms, your physician may recommend surgery to remove the blockage at the foramen magnum and restore the normal flow of CSF. This will stop the disease from getting worse, as well as stabilize or alleviate your symptoms. The particular procedure your surgeon may recommend will depend upon multiple factors, including your age, disease progression and particulars of your case.

Dural Opening Chiari Decompression:

The goal of dural opening Chiari Decompression is to prevent further injury to the spinal cord by making space for the lower regions of the cerebellum outside of the spinal canal while also, hopefully, providing relief from some of the associated symptoms.

Cervical Laminectomy:

When a surgeon performs a cervical laminectomy, he or she is removing the back section of the upper vertebral bone(s) in order to help create space and alleviate pressure around the spinal cord. This procedure is often performed in combination with a Suboccipital Craniectomy in patients with Chiari Type 1.

Spinal Fusion:

Spinal fusion is a procedure performed in combination with posterior fossa decompression, for patients who have spinal instability due to coexisting conditions that cause additional issues, such as Ehlers-Danlos syndrome.

Transasal / Transoral Decompression:

Transasal / Transoral decompression is a procedure where the surgeon removes a section of a vertebra causing compression in patients with Chiari in conjunction with other conditions such as basilar invagination.

Cerebrospinal Fluid (CSF) Diverson:

CSF diversion uses a flexible tube to direct CSF around the blockage, allowing it to flow to another area of the body and be absorbed.

Neuromonitoring:

In conjunction with these procedures, neuromonitoring is performed by trained specialists. Neuromonitoring allows surgeons to identify subtle improvements in nerve pathway functioning in the operating room at critical surgical steps. Neurosurgeons use this during surgery as a safeguard to help prevent complications when operating on delicate structures such as the brain and spinal cord.

Minimally Invasive Chiari Decompression:

This minimally invasive approach, pioneered by our surgeons at Neurosurgeons of New Jersey, achieves the same result as a standard decompression but through a much smaller incision and with added benefits.

Posterior Fossa Decompression:

The surgeon, operating through a small incision with endoscopic or microscopic tools, will remove sections of the occipital bone and/or spine in order to create additional room for the cerebellum.

Neuromonitoring:

In conjunction with these procedures, neuromonitoring is performed by trained specialists. Neuromonitoring allows surgeons to identify subtle improvements in nerve pathway functioning in the operating room at critical surgical steps. Neurosurgeons use this during surgery as a safeguard to help prevent complications when operating on delicate structures such as the brain and spinal cord.

Our Chiari Specialists

Dr Richard Anderson

Dr. Richard C.E. Anderson

MD, FACS, FAAP

Pediatric Chiari Specialist

Dr Luigi Bassani

Dr. Luigi Bassani

MD

Pediatric Chiari Specialist

Dr. Neil Feldstein

Dr. Neil A. Feldstein

MD, FACS

Pediatric Chiari Specialist

Dr. Paul Gigante

Dr. Paul R. Gigante

MD

Adult Chiari Specialist

Dr. Gaetan Moise

Dr. Gaetan Moise

MD, FAANS

Adult Chiari Specialist

Dr. David Estin

Dr. David Estin

MD, FACS

Adult Chiari Specialist

Dr. Jonathan Lustgarten

Dr. Jonathan H. Lustgarten

MD

Adult Chiari Specialist

Dr. Ty Olson

Dr. Ty J. Olson

MD, FAACS

Adult Chiari Specialist

Our Chiari Malformation Patient Stories

"Dr. Anderson was the 2nd neurosurgeon we saw after our 7-year-old son was diagnosed with a Chiari Malformation. My son was out of the hospital within 2 days, the incision is barely noticeable after only 1 month and now he is a completely different kid. Dr. Anderson is an amazing neurosurgeon, great with the kids and families. He gave us our happy, healthy child back!"

E. BoscioParent of Child Patient

"I can't say enough good things about Dr. Moise. He performed surgery on me October, 2013 for Chiari Malformation. From the moment I met him, I knew I was in the right hands. I am so grateful for his expert surgical skills, his compassionate bedside manner and his disposition. He gave me my life back and made me healthy again. I am forever grateful."

Linda E.Patient

"My daughter had surgery on her spinal cord done by Dr. Feldstein and he is the best! Kind, intelligent and highly skilled - he is everything you want in a doctor for your child! I am a surgical RN and I am a tough critic, but Dr. Feldstein receives an A rating from me!"

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