Chiari Malformation

Treatment

Neurologists and neurosurgeons at Mayo Clinic take a conservative approach to treating Chiari malformation to spare patients unnecessary surgery that will not alleviate their symptoms. While many people may have a subtle Chiari malformation that is evident on an MRI, few malformations are serious enough to warrant treatment.

The goal of treatment is to halt or reverse the progression of signs and symptoms. This may be accomplished by surgery to relieve the pressure on the brain stem, cerebellum and spinal cord, and to re-establish spinal fluid circulation.

See an illustration of the surgical treatment of Chiari malformation.

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The surgical procedure (posterior fossa craniectomy or posterior fossa decompression), involves removing a small section of bone at the back of the head to relieve pressure by making more room for the cerebellum. The covering of the brain (dura) may also be enlarged with a patch created from synthetic material or tissue from the patient's leg muscle. This helps make more room for the brain and the spinal cord and helps to establish the flow of cerebral spinal fluid. The operation generally takes two to three hours. Recovery time in the hospital could take from two to four days.

A cervical laminectomy is also performed. This involves the removal of the bone forming the back of the vertebra or lamina. Both the posterior fossa decompression and the cervical laminectomy are done at the same time, through the same surgical incision in the back of the head and upper neck.

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

Surgery performed on patients who can truly benefit from the operation often successfully relieves the symptoms of Chiari malformation.