Chiari Malformation

Treatment of Children

The goal of Mayo Clinic's multispecialty team of pediatric experts is to find the most appropriate treatment for the child with a Chiari malformation. They work closely with the child's family to help them understand their child's condition and learn how they can help improve their child's health and well-being.

Children who come to Mayo Clinic are treated at Mayo Eugenio Litta Children's Hospital in Minnesota, a state-of-the-art, family-friendly children's hospital within Saint Marys Hospital.

A Chiari malformation found in infants and children is most often part of a larger syndrome that includes myelodysplasia (spina bifida or myelomeningocele). Treating this syndrome is complex, requiring skilled and experienced practitioners with state-of-the-art tools at their disposal.

The full extent of problems associated with a Chiari malformation are usually not completely understood at birth, but may show up as the child grows and develops. Children born with a Chiari malformation require frequent examinations and diagnostic testing to monitor the condition.

Diagnosis in Children

In general, the development of a diagnosis is similar to the procedure used in adults. (See diagnosis.) However, other factors are also considered in children.

If a Chiari malformation is part of other congenital (present at birth) defects, the diagnosis may be made at birth. Otherwise, a diagnosis is made after the onset of signs and symptoms, and after diagnostic testing.

The physician looks for developmental milestones, such as the age the child sat up, crawled or walked, because a Chiari malformation can be associated with other neuromuscular disorders. The condition may be associated with hydrocephalus, so the physician measures the child's head to see if the size is abnormal.

The most definitive test is magnetic resonance imaging (MRI) of the skull. The noninvasive nature of this test, and the superior images it provides, has led to a greater use of MRI imaging in children with relatively nonspecific symptoms of headache and curvature of the spine. As a result, Chiari malformations are increasingly being discovered earlier, sometimes before more serious neurologic damage occurs.

Treatment Options in Children

Treatment options for children are largely the same as for adults. (See treatment.) However, there is the option for a less invasive surgery for children.

As with adults, the surgery may be modified if there is a syrinx (fluid-filled cavity in the spinal cord) present or if the child has hydrocephalus. Most children who have the surgery do quite well and their symptoms improve.

In some cases, the dura (tough membrane covering the brain stem and spinal cord) is not opened or patched. In children, most improvement seems to result from enlarging the bony structures surrounding the descending brain tissue, so it may not be necessary to make an incision in the dura (as is done in adults).

Treatment Team

This disease is treated by pediatric specialists in Child and Adolescent Neurology and Neurosurgery.

Appointments

For appointments or more information, call the Central Appointment Office at (507) 538-3270 7 a.m. to 7 p.m. Central time Monday through Thursday, 7 a.m. to 5 p.m. Friday.