Chiari Malformation is a condition where the lower part of the brain pushes down to into the spinal canal. This is a congenital defect at the back of the head where the brain and spinal cord connect. It is also known as Arnold Chiari Malformation. This condition occurs when the part of the skull is abnormally distorted or relatively small.
If you happen to travel for the treatment of Chiari Malformation, you would have to carefully plan out your travel expenses and the journey. You have to decide for the treatment center and hotels to stay for the treatment of Chiari Malformation. Be sure to take up the appointment in advance for the treatment, so that you do not face any trouble.
If you already know where you will be going for the treatment of Chiari Malformation, or a consultation or a second opinion then click here to plan your travel. Otherwise, click here to get the information about facilities that specialize in Chiari Malformation.
If you cannot afford travel for medical treatment, please consult our directory of charitable organizations that can help arrange no-cost transportation for you.
For more information: (links to the section below)
- About Chiari Malformation
- Types of Chiari Malformation
- Where to go for Chiari Malformation?
- Treatment of Chiari Malformation
- Risks associated with Chiari Malformation
- Who can go for the treatment?
About Chiari Malformation
Chiari Malformation is structural defects in the cerebellum part of the brain. This results in downward displacement of the cerebellar tonsils through the opening at the base of the skull. Chiari malformation exists from the birth but is usually diagnosed during the teen years of a child. This malformation is named after Austrian pathologist Hans Chiari.
Chiari malformation develops when a part of the skull is smaller than the normal that pushes down the cerebellum into the foramen magnum and spinal cord. This process results in pressure on cerebellum and brain stem and may hamper the activities controlled by these parts of the brain. This also further blocks the flow of cerebrospinal fluid (CSF). The CSF is known to surround and cushion the brain and spinal cord along with removing waste products from the brain.
The medical science classifies Chiari malformation into four types depending upon the anatomy of the brain tissue which is displaced into the spinal canal, and if the developmental abnormalities of the brain and spine are present.
Types of Chiari malformation
- Chiari I malformation- Chiari I malformation is the most common type of malformation. In this peg-like cerebellar tonsils are relocated into the upper cervical canal through the foramen magnum. This type is generally unnoticeable as the symptoms arise in the adolescent or adult years of life. In the condition of Chiari I malformation, the base of the skull and spinal cord are not shaped correctly.
- Type II- In Chiari Type II malformation, a greater amount of cerebellum extends into the spinal cord as compared to Type I. in this condition, part of the back of the brain reallocates downhill through the bottom of the skull area. This type is typically seen in infants who are born with spina bifida which is a neurological problem where the spinal cord and surrounding parts develop outside the body instead of developing inside.
- Type III- Type III Chiari malformation is a very rare and severe condition. In this type of classification, some of the cerebellum and the brain stem stick out through the abnormal opening in the back of the skull. Sometimes, this can also include the membranes that surround the brain and the spinal cord.
- Type IV- This type of Chiari malformation involves an incomplete or underdeveloped brain cerebellum in a condition known as cerebellar hypoplasia. This is also a rare form Chiari malformation where cerebellum is located on the normal position but parts of it might be missing which leads to the visibility of brain and spinal cord.
Where to go for Chiari Malformation?
In USA there are various facilities that can offer treatment for Chiari malformation, if you have already determined your child’s symptoms from early stages. As there are more precautions and management rather than the treatment, quite many hospitals cater to the treatment of Chiari malformation.
The following health care facilities would help you largely deal with the diagnosis and treatment of the malformation:
- Coming Soon
The medical management in any health institute would include frequent physical examinations and diagnostic testing to keep in observation the growth and development of the brain, spinal cord, skull and nervous system.
Some forms of Chiari malformation might require surgery to be treated so one must travel to the health care facility that provides a proper team neurosurgeons and physicians to properly treat Chiari malformation. Also after surgery, follow-ups and complete medical attention is needed to avoid the recurrence of symptoms. So, one should think carefully of they are travelling for the treatment of Chiari malformation.
During and after the treatment, parents should watch out their kids for any signs that would affect the child’s neurological status. Things like breathing problems, degree of alertness, speech or feeding problems and uncoordinated movement in arms and legs should be watched out for.
In the present case scenario, there is no test so as to determine if your baby would be born with Chiari malformation or not. As people with Chiari Malformation are born with certain conditions like spina bifida, children with these defects are often tested for malformations that can indicate the presence of Chiari Malformation in a child.
But in a few cases, malformations can be detected through imaging before birth. Many individuals with Chiari Malformation have no visible symptoms and the presence of Chiari Malformation can be only discovered once the person is getting treated for some other disorder.
In a physical examination that the doctor would take up, he would check a person’s memory, cognition, balance which are the functions controlled by cerebellum and , touch, reflexes, sensation, and motor skills that are the functions controlled by spinal cord. Imaging sensors like MRI, X-Rays and CT scan can be furthermore helpful in producing images that can confirm a physician’s doubts of Chiari Malformation.
Sometimes, also in physical examination, the measure of the circumference of the head of the child is taken up and compared with the normal head size to determine Chiari Malformation. This malformation is relatable with other neuromuscular disorders. Developmental delays in a child’s brain and activities may require further medical follow-ups for essential problems.
Treatment of Chiari Malformation
Like every other disorder, Chiari Malformation’s symptoms and their severity define the treatment of the malformation. If there are no visible symptoms, then the doctors may recommend regular monitoring of the patient with MRI. If the affected individual is experiencing headaches or pains, prescribed painkillers are given to suppress these.
If the symptoms are severe and worse, then other options like surgery are considered. In most of the cases, surgery is the only treatment that is considered in order to replenish further damage to the central nervous system. Many times, more than one surgery is necessary for the treatment of Chiari Malformation.
The most common form of surgery to treat Chiari Malformation is posterior fossa decompression. This surgical procedure creates more space for cerebellum and relieves the pressure on spinal cord. The process involves making an incision at the back of the head and removal of a small bone at the bottom of the skull.
Infants and children with Chiari Malformation require a surgery to reposition their spinal cord and close the opening of their back. Research suggests that this surgery is the most effective when done prenatally that is when the child is still in womb instead of after the birth of the child as suggested by National Institutes of Health (NIH). This surgery places the cerebellum and spinal cord in a more normal way.
Another corrective procedure that can be used is Endoscopic third ventriculostomy (ETV) where a small hole is made in the brain to drain out the entire extra trapped fluid.
The motive of such surgeries is to stop the current symptoms from getting worsened up. The improvements after surgery like reduced headaches are observed. There is sometimes, no progress seen after surgery and the symptoms can turn worse. There is a small risk of paralysis or stroke after surgery, so you need to be sure of this and talk to your surgeon before. You must take the expert opinion.
Risks associated with Chiari Malformation
There is no exact cause known for Chiari malformation. But, there are theories that say that exposure to the fetus various harmful substances and genetic problems or syndromes can be the reason for Chiari malformation. The risk of contracting Chiari malformation during pregnancy can be caused from the following reasons:
- Exposure to hazardous chemicals/substances
- Lack of proper vitamins and nutrients in the diet
- Prescription of illegal drug and alcohol consumption
Along with Chiari malformation, other disorders like Hydrocephalus, Spina bifida, Syringomyelia, Tethered cord syndrome and Spinal curvature are other common risk factors that are associated with Chiari malformation.
Who can go for the treatment?
Statistics show that Chiari malformation happens one in every 1,000 births. However, recent diagnostic imaging shows that it is a much more common malformation. The major complication of this syndrome is that the symptoms of Chiari malformation are not visible and would only show when the child reaches adulthood or adolescence. This malformation occurs more commonly in women than in men. Type II Chiari malformations are more common in certain groups such as Celtic descent.
Headache is the most prominent sign of Chiari malformation particularly after sudden coughing, sneezing or straining. Many times individuals with Chiari malformation would not show any symptom at all. For other individuals, symptoms may vary depending upon the compression of the tissue and the buildup of CSF pressure.
Kids with Chiari malformation have problems in swallowing, irritability when being fed, too much drooling, a weak cry, muffling or vomiting, weakness in arms, a stiff neck, breathing problems, developmental impediment and an incapacity to gain weight. Other common symptoms in the cases of Chiari malformation include:
- Neck pain
- Buzzing in the ears (tinnitus)
- Sleep disorders and sleep apnea
- Facial pain
- Pupillary dilation
- Rapid heartbeat, fainting, extreme thirst