Chiari malformations occur through no fault of your own. They are caused by a structural defect in the base of the skull and the cerebellum, which helps control your balance. In a healthy skull, the cerebellum and parts of the brain stem sit above the foramen magnum, a small opening through which the spinal cord can safely pass through. When the cerebellum extends through the foramen magnum and into the upper spinal canal, it is known as a chiari malformation.
If the cerebellum extends into the spinal canal, numerous problems can develop. Its extension through the foramen magnum can lead to excessive pressure on the structure or interruptions in the normal flow of cerebrospinal fluid. This can lead to a number of symptoms like headaches, dizziness, muscle weakness, vomiting, spinal stenosis and much more.
Surgically Treating Chiari Malformation
In some cases, chiari malformation can be asymptomatic, meaning it doesn’t result in symptoms or disruption of every day life. In these instances, treatment may be nothing more than remaining aware of potential symptoms and regular monitoring with the assistance of an MRI.
However, most cases of chiari malformation are symptomatic and call for treatment, and unless the only symptom is minor headaches, which may be treated with medications, surgery is typically the only successful treatment option. Thankfully, surgery is usually very successful at resolving symptoms, but more than one surgery may be necessary to completely correct the issue. Here’s what happens during the most common chiari malformation surgery called a posterior fossa decompression.
1. The patient is hooked up to a monitoring device and given anesthesia to be put into a sleep-like state.
2. The surgeon makes a small incision on the back of the person’s head.
3. The surgeon carefully removes a small portion of the bone at the bottom of the skull to depressurize the area.
4. In some cases, the surgeon may also remove the arched bony roof of the spinal canal called the lamina. Once these areas are removed, cerebrospinal fluid should flow normally.
5. If testing shows that there is still pressure in the brain and spinal cord, the surgeon then makes an incision in the dura – the protective covering of the brain and spinal cord.
6. The surgeon performs a procedure called electrocautery to remove small cerebellar tonsils, which have no known function. This again helps to depressurize the area without causing neurological dysfunction.
7. Finally, the surgeon sews a dura patch in place to expand the space around the tonsils. Once secured, the surgeon closes up the openings and the patient is sent to a recovery ward.
The surgery has great results when performed by an experienced neurosurgeon. Chairi malformations effect about 1 in 1,000 people, so while the condition is rare, those who are dealing with the condition need to know that knowledagble help is available. If you’ve been dealing with recent headaches, loss of balance or back issues, reach out to Dr. David Chang today. He can help you get to the bottom of your condition, and develop treatment options to get you back on the road to recovery.