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Treatments and drugs
By Mayo Clinic staffTreatment for Chiari malformation depends on the severity and the characteristics of your condition.
If you have no symptoms, your doctor likely will recommend no treatment other than monitoring with regular examinations and MRIs.
When headaches or other types of pain are the primary symptom, your doctor may recommend pain medication.
Reducing pressure by surgery
Doctors usually treat symptomatic Chiari malformation with surgery. The goal is to stop the progression of changes in the anatomy of your brain and spinal canal, as well as ease or stabilize your symptoms.
When successful, surgery can reduce pressure on your cerebellum and spinal cord, and restore the normal flow of spinal fluid.
In the most common surgery for Chiari malformation, called posterior fossa decompression, your surgeon removes a small section of bone in the back of your skull, relieving pressure by giving your brain more room.
In many cases, the covering of your brain, called the dura mater, may be opened. Also, a patch may be sewn in place to enlarge the covering and provide more room for your brain. This patch may be an artificial material, or it could be tissue harvested from another part of your body.
Your doctor also may remove a small portion of the spinal column to relieve pressure on your spinal cord and allow more space for the spinal cord.
The surgical technique may vary, depending on whether a fluid-filled cavity (syrinx) is present, or if you have fluid in your brain (hydrocephalus). If you have a syrinx or hydrocephalus, you may need a tube (shunt) to drain the excess fluid.
Surgical risks and follow-up
Surgery involves risks, including the possibility of infection, fluid in your brain, cerebrospinal fluid leakage or problems with wound healing. Discuss the pros and cons with your doctor when deciding whether surgery is the most appropriate alternative for you.
The surgery reduces symptoms in most people, but if nerve injury in the spinal canal has already occurred, this procedure won't reverse the damage.
After the surgery, you'll need regular follow-up examinations with your doctor, including periodic imaging tests to assess the outcome of surgery and the flow of cerebrospinal fluid.
- Chiari malformation fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/chiari/detail_chiari.htm. Accessed May 8, 2013.
- Chiari malformation. American Association of Neurological Surgeons. http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Chiari%20Malformation.aspx. Accessed June 5, 2013.
- Chiari malformations. http://www.uptodate.com/home. Accessed May 8, 2013.
- Ropper AH, et al. Adams & Victor's Principles of Neurology. 9th ed. New York, N.Y.: The McGraw-Hill Companies; 2009. http://www.accessmedicine.com/content.aspx?aID=3637206&searchStr=arnold-chiari+malformation#3637206. Accessed June 5, 2013.
- Sekula RF, et al. The pathogenesis of Chiari I malformation and syringomyelia. Neurological Research. 2011;33:232.
- Riggin EA. Decision Support System. Mayo Clinic, Rochester, Minn. May 23, 2013.
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