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Neuromedicine Neurological Surgery Chiari I Malformation About Chiari Malformation Anatomy of the Brain Diagnosis Neurological Exam Questions to Ask Recovery Symptoms Treatment

Chiari Type I Malformation Treatment

The treatment of choice for persons with Chiari I malformation, symptoms associated with the malformation, and clinical findings on examination is surgery to decompress the area.

Operative procedure, posterior fossa decompression

• The patient is taken to the operating room, and placed under general anesthesia.
• The patient is then positioned face down with the head supported in a special head holder.
• A small area in the back of the head is shaved and prepared for surgery.
• A midline incision is created, which is about three inches in length.
• A small area of the bone at the base of the skull is removed to enlarge the posterior fossa.
• The area is opened to enable visualization of the tough outer membrane of the brain called the dura.
• An incision may need to be made in the dura to see the cerebellum and upper spinal cord.
• The flow of CSF is then evaluated.
• In some cases, the cerebellar tonsils are shrunk using a tiny instrument, called the electrocautery.
• Shrinking the cerebellar tonsils is done in effort to restore normal CSF pathway if there is a blockage of the flow.
• A piece of synthetic material, a tissue graft, or a piece of the natural muscle (called periosteum) is then used to patch the area in an effort to enlarge the region of the cerebellum and spinal canal.
• The incision is then closed with sutures below the skin and staples on the skin.
• The procedure generally takes three to four hours. The patient is usually awakened in the operating room and transferred to the recovery room for close observation.

Operative risk

There are certain risks to every operation. Although every effort to avoid any risk is taken, the operative risks include (but are not limited to) bleeding from the operative site, infection, spinal fluid leak and neurologic damage. The specific risks are discussed with each patient prior to surgery.