If you have been diagnosed with a Chiari malformation, one of the first questions to cross your mind was likely, “Is there a cure for Chiari malformation?” The good news is that there are very effective treatment options available to help provide relief from your symptoms. While these treatments do typically resolve symptoms of Chiari malformation, there are rare instances when symptoms return after a period of time. To ensure this does not happen, your doctor will recommend the most appropriate treatment for you based on your individual condition.
About Your Chiari Malformation
Before explaining the different Chiari malformation treatment options, it can be helpful to understand your condition and how it developed. As a body develops, the brain and skull grow together, maximizing protection of the delicate brain by having just enough space within the skull. However, there are cases where the skull does not grow large enough in the area that houses the cerebellum, part of the back (posterior) brain, leading to a Chiari malformation.
When this occurs, the softer tissues of the brain get forced out of a hole at the base of the skull called the foramen magnum. The portion of the cerebellum that extends beyond the skull is called the cerebellar tonsils. Because the foramen magnum is the exit point for the brainstem and spinal cord, the cerebellar tonsils can press on these structures or create a blockage, hindering the flow of cerebrospinal fluid (CSF).
Is There a Cure for Chiari Malformation?
“Cure” is a very specific word, implying that your condition is completely resolved and will not return. Because your Chiari malformation developed as you were growing, it is unlikely to return following surgery. However, there are cases where symptoms may not be fully relieved or may return after a period of time. Should this occur, it means you may require further treatment to provide adequate relief. However, most patients will not require these extra treatments and will essentially be cured of the symptoms related to their Chiari malformation. Be sure to discuss your individual condition with your personal doctor, who will be the best person to give you an idea of what to expect following your specific treatment.
Chiari Malformation Treatment Options
Surgical treatment options all have the same goal, which is to create space and/or relieve pressure. Surgery is typically reserved for patients that have failed non-surgical treatment and/or have rapidly worsening neurological symptoms. Your doctor will recommend the treatment option that is most appropriate for your individual circumstances and may utilize a combination approach, depending on your treatment needs.
Generally speaking, there are two categories of Chiari malformation treatment options: traditional methods or minimally invasive treatments. Again, both accomplish the same outcomes, but sometimes one approach will be more appropriate than another for you as an individual.
Dural Opening Chiari Decompression
One of the most common treatments for Chiari malformation is dural opening Chiari decompression. During this procedure, the neurosurgeon makes an incision and removes a small section of skull. He or she will create an opening in the dura, the delicate membrane that covers the brain, then insert a patch that will allow the dura to stretch, increasing the space available. The section of bone is replaced and the tissues are closed using sutures or staples.
Another traditional treatment, cervical laminectomy, is often performed in conjunction with dural opening Chiari decompression. The goal is to alleviate pressure on the spinal cord by removing a small section of bone from the uppermost vertebrae, again creating more space. Your doctor may recommend this treatment if there is concern about damage to the spinal cord.
Cerebrospinal Fluid (CSF) Diversion
A third less frequently used treatment is CSF diversion. This procedure is different than those above in that it involves placement of a shunt to divert CSF that has built up due to a blockage. By carrying the CSF to another area of the body, such as the abdomen, excess CSF can be reabsorbed into the bloodstream and pressure due to fluid buildup is relieved.
Minimally Invasive Treatments
During minimally invasive Chiari malformation treatment, the neurosurgeon utilizes microscopic instruments and visualization to reduce the size of the incision and disturb less of the surrounding soft tissues. Procedures are generally shorter, and patients typically experience shorter recovery times with less postoperative pain.
Minimally Invasive Chiari Decompression
Minimally invasive Chiari decompression is similar to dural opening Chiari decompression in that it creates more space, but there are significant differences. By utilizing specialized tools and using a minimally invasive approach, the neurosurgeon is able to create more space for the cerebellum without the need for a dural patch. The incision site is also smaller than dural opening Chiari decompression, again leading to a shorter and less painful recovery period.
Non Dural Opening Posterior Fossa Decompression
Posterior fossa decompression is also performed using a minimally invasive approach. The neurosurgeon removes a small section of the back of the skull in an area called the posterior fossa, again creating more space for the brain and relieving pressure. This helps restore the natural flow of CSF and prevent further damage to the spinal cord and/or brainstem.
Understanding Chiari Malformation
Learning more about your Chiari malformation is a great way to gain peace of mind following your diagnosis. As you develop a deeper understanding of your condition and the available treatment options, you will have a better idea of what to expect as you move along your treatment path.