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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.
When headaches or other types of pain are the primary symptom, your doctor may recommend pain medication. Some people experience symptom relief with anti-inflammatory or pain-relieving agents, such as indomethacin (Indocin). This approach may prevent or delay the need for surgery.
Reducing pressure by surgery
Surgery is the approach doctors use most often to treat symptomatic Chiari malformation. The goal is to stop the progression of changes in the anatomy of the brain and spinal canal, as well as ease or stabilize symptoms. When successful, surgery can reduce pressure on the cerebellum and the spinal cord, and restore the normal flow of spinal fluid.
In the most common operation for Chiari malformation — called posterior fossa craniectomy or posterior fossa decompression — your surgeon removes a small section of bone in the back of the skull, relieving pressure by giving the brain more room. The covering of the brain, called the dura, is then opened, and a patch is sewn in place to enlarge the covering and provide more room for the brain. This patch may be an artificial material, or it could be tissue harvested from your own leg or neck. The exact technique may vary, depending on whether a fluid-filled cavity is present, or if you have hydrocephalus. The operation takes about two to three hours, and recovery in the hospital usually requires two to four days.
Surgical risks and follow-up
The use of surgery carries risks — the possibility of infection or problems with wound healing. Discuss the pros and cons with your doctor when deciding whether surgery is the best alternative for you. The operation 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 operation, 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.
- NINDS Chiari malformation information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/chiari/chiari.htm. Accessed Sept. 23, 2010.
- Chiari malformation. American Association of Neurological Surgeons. http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Chiari%20Malformation.aspx. Accessed Sept. 24, 2010.
- Syringomyelia. American Syringomyelia and Chiari Alliance Project. http://www.asap.org/index.php/disorders/syringomyelia/. Accessed Sept. 24, 2010.
- Developmental diseases of the nervous system. In: Ropper AH, et al. Adams and Victor's Principles of Neurology. 9th ed. New York, N.Y.: The McGraw-Hill Companies; 2009. http://www.accessmedicine.com/content.aspx?aID=3637082. Accessed Sept. 24, 2010.
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