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Chiari Malformation: Type 1

Introduction

Chiari malformation is a condition in which brain tissue protrudes into the spinal canal.  As a result of the obstruction of the normal pathways of cerebrospinal fluid (CSF), a build up of fluid on the brain (hydrocephalus) or in the spine (syringomyelia) may occur.  Although Chiari malformation is uncommon, modern imaging techniques and comprehensive exams have allowed physicians to begin making more accurate diagnoses.

Chiari Malformation Type 1 is one of the four most common types of the condition.  Patients with type 1 typically do not have symptoms until late childhood or adulthood.  This is because the malformation does not develop until the skull and brain are growing.  In contrast, patients with other types of Chiari malformation are often diagnosed in utero, during birth, or during early infancy.

Symptoms

The symptoms of Chiari malformation type I may include headaches, tinnitus, nausea, facial pain, difficulty swallowing, visual symptoms, or muscle weakness. Untreated Chiari malformation type 1 may also result in the development of fluid filled cavities in the brain (hydrocephalus) or spinal cord (syrinx) which may eventually lead to syringomyelia. This can lead to irreversible damage to the brain or spinal cord.

Although Chiari malformation occurs in 1 of 2,000 people, the number of patients who exhibit symptoms is significantly less.

Diagnosis

The diagnosis of Chiari malformation type 1 is made through a combination of patient history, neurological examination, and Magnetic Resonance Imaging (MRI). Special flow MRI scans called CINE studies are sometimes necessary to make the diagnosis. Additional imaging techniques that may be used involve the use of 3-D CT imaging of the brain and skull.  Early diagnosis of Chiari malformation type 1 can lead to treatment before the formation of syrinx.

Treatment

Treatment of Chiari malformation Type 1 varies based on a number of factors, including the severity of symptoms and whether or not syrinx exists. When the patient has no symptoms or neurological findings, physicians will often manage the condition by observation only.  When the patient has symptoms that are mild but manageable, a physician may prescribe medications to help reduce the pain.

Surgery may become necessary if a patient notices symptoms that are progressive, observes a decline in neurological function, and/or experiences an enlarging syrinx.  The surgery typically begins by making an incision in the middle of the back of the skull, which extends midway down the back of the neck. Muscles are gently separated from the base of the skull as well as from the back of the first cervical vertebra.

Next, a craniectomy is performed to enlarge the opening of the base of the skull and create additional CSF flow space next to the brain. To do this, a specialized surgical instrument is used to carefully shave a small piece of bone about the size of a silver dollar.  The first cervical vertebra is then carefully removed during a procedure called a laminectomy.  In some cases, removal of additional cervical lower lamina may be necessary.

Conclusions

Patients with Chiari malformation type 1 are often asymptomatic, and only learn that they have the condition after it is incidentally found during an evaluation for other non-related conditions.   

Once a Chiari malformation is diagnosed, it is important to get an evaluation by a neurosurgeon.  Early diagnosis and treatment of this condition is critical.  Surgical treatment for symptomatic Chiari malformation type 1 is usually very successful when treated promptly.  Many patients experience significant improvements in their symptoms after surgery and are able to return to daily life without activity restrictions. 

Princeton Brain & Spine Care doctors offer state-of-the-art diagnosis and treatment of this serious condition.

 

LastUpdate: 2016-05-11 17:47:47

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