Diagnosis
Imaging tests are used to diagnose Chiari malformation. These tests may include:
Magnetic resonance imaging (MRI). An MRI is often done on the brain and the spinal cord in the neck to diagnose Chiari malformation. An MRI uses powerful radio waves and magnets to create a detailed view of the body.
This safe, painless test creates detailed 3D images of structural differences in the brain that may be causing symptoms. It also can provide images of the cerebellum and show whether it goes into the spinal canal.
An MRI may be repeated over time, and it can be used to watch the condition.
- Computerized tomography (CT) scan. Other imaging tests such as a CT scan also may be useful. A CT scan uses X-rays to make cross-sectional images of the body. This can help to show brain tumors, brain damage, bone and blood vessel issues, and other conditions that may be linked to Chiari malformation.
- Fetal ultrasound. An ultrasound done during pregnancy may be able to find Chiari malformation in a fetus.
More Information
Treatment
Treatment for Chiari malformation depends on the situation. If it's not causing symptoms, no treatment may be needed. But even without symptoms, the condition may need to be checked over time with exams and MRIs.
Medicine
When headaches or other types of pain are the primary symptom of Chiari malformation, pain medicine may be used to help ease pain.
Surgery
Chiari malformations that cause symptoms are often treated with surgery. The goal is to prevent more damage to the body. Surgery also can ease or stabilize symptoms.
Surgery lowers pressure on the cerebellum and spinal cord and restores the usual flow of spinal fluid through the brain and spinal cord.
The most common surgery for Chiari malformation is called posterior fossa decompression. It involves removing a small piece of bone in the back of the skull. This eases pressure by giving the brain more room.
During surgery, the covering of the brain, called the dura mater, may be opened. Also, a patch may be sewn onto the dura mater to enlarge the covering and give the brain more room. This patch may be an artificial material, or it could be tissue taken from another part of the body.
The surgeon also may remove a small part of the upper spinal column to ease pressure on the spinal cord and allow it more space.
If there's a fluid-filled cavity in the spinal cord, called a syrinx, it often gets smaller or even disappears completely after posterior fossa decompression surgery.
If there's too much fluid in the brain, a condition called hydrocephalus, a tube called a shunt may be placed during surgery to drain the extra fluid into another part of the body. Hydrocephalus is not common in type 1 Chiari malformations. But it often requires treatment in people who have type 2 Chiari malformations.
Surgical risks and follow-up
Surgery involves risks, including the possibility of infection, fluid in the brain, leaking cerebrospinal fluid or trouble with wound healing. Talk about the risks and benefits with your surgeon when making decisions about surgery.
Surgery for Chiari malformation eases symptoms in most people. But if nerve injury in the spinal canal has already happened, surgery won't reverse that damage.
After surgery, you'll need regular follow-up exams with your healthcare professional. This includes regular imaging tests to check the outcome of surgery and the flow of cerebrospinal fluid.
Clinical trials
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.
Preparing for your appointment
You're likely to start by seeing your primary healthcare professional. But when you call to make an appointment, you may be referred to a doctor trained in brain and nervous system conditions, called a neurologist. If you need surgery, you may be referred to a doctor trained in surgery of the brain and nervous system, called a neurosurgeon.
Here's some information to help you get ready for your appointment.
What you can do
When you make the appointment, ask if there's anything you need to do beforehand, such as not eat or drink before a test. Make a list of:
- Your symptoms, including any that don't seem related to the reason for your appointment.
- Key personal information, including major stresses, recent life changes and family medical history.
- All medicines, vitamins and other supplements you take, including the doses.
- Questions to ask your healthcare professional.
Take a family member or friend along, if possible, to help you remember the information you're given.
For Chiari malformation, some basic questions to ask your healthcare professional include:
- What is likely causing my symptoms or condition?
- Other than the most likely cause, what are possible causes for my symptoms or condition?
- What kinds of tests do I need?
- Do I need treatment?
- If you don't think I need treatment now, how will you watch for changes in my condition?
- If you recommend surgery, what should I expect from my recovery?
- What is the risk of complications from surgery?
- What is my long-term outlook after surgery?
- I have other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Should I see a specialist?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend?
Be sure to ask any other questions you may have.
What to expect from your doctor
Your healthcare professional is likely to ask you some questions, such as:
- When did your symptoms begin?
- Do you have symptoms all the time, or do they come and go?
- If you have head and neck pain, does sneezing, coughing or straining make it worse?
- How bad is your head and neck pain?
- Have you noticed any change in your coordination, including trouble with balance or with hand coordination?
- Do your hands and feet feel numb, or do they tingle?
- Do you have any trouble swallowing?
- Do you have episodes of dizziness or faintness? Have you ever passed out?
- Have you developed any issues with your eyes and ears, such as blurred vision or a ringing or buzzing in your ears?
- Have you had any bladder issues?
- Has anyone ever noticed that you stop breathing during sleep?
- Do you take pain relievers or use other approaches to ease discomfort? Does anything seem to work?
- Do you have any other symptoms, such as hearing loss, feeling very tired, or changes in your bowel habits or appetite?
- Have you been diagnosed with any other health conditions?
- Has anyone in your family been diagnosed with Chiari malformation?