Treatment Options For Adults With Arnold Chiari Malformation

Arnold Chiari Malformation is usually developmental, meaning that they are formed as the body develops before birth. Many Chiari patients, though, don’t present with symptoms until they reach adulthood. They also don’t receive treatment until they are older. But for those with symptomatic malformations but have unsuccessfully to non-surgical treatments, there are several tested and proven surgical treatments available.



Conventional And Minimally Invasive Treatments


These are the two general options that the surgeon will use. Conventional or traditional surgery involves open surgery, which includes cervical laminectomy and decompression surgery. These two procedures have been proven to treat patients effectively. 


However, with the advent of new technology, minimally invasive surgery has become possible. This involves the surgeon using specialized medical equipment to make very small incisions to decrease blood loss and tissue damage. 


Majority of patients who can undergo conventional surgery can also opt to do the minimally invasive approach. In fact, in the current years, specialists have preferred the traditional method because it is equally effective and with more advantages to patients.


Some benefits can Chiari patients can expect from the minimally invasive approach include: 


  • Lesser pain and shorter hospital stay
  • Shortened recovery time
  • Decreased blood loss
  • The procedure is shorter than the traditional approach
  • Relatively quicker time to go back to work and do normal daily activities


A List of Surgical Treatments For Adults With Chiari Malformations


There are several options that patients can choose from to help alleviate their condition. However, it is important to remember that the goal is one and the same – to increase space for the brain and spinal cord and decrease the pressure that has been building up in the said structures. 

  • Decompression Surgery. This is the most common procedure preferred by patients and used by surgeons. What the surgeon does it primarily incise the patient’s neck from the back to remove a small part of the skull. He then opens and expands the dura mater. Minimally invasive decompression is another option that results in decreased pain and healing time and reduced hospital stay.




  • Cervical Laminectomy. This procedure can be used together with decompression surgery. Aside from removing a portion of the skull, the surgeon will also remove a portion of the upper vertebrae to make more space within the spinal cord. These two procedures combined results in an increased space in both the spinal cord and the cerebellum.




  • Spinal Fusion. For a Chiari patient with spinal instability, spinal fusion is the treatment of choice. The head and neck are protected by placing specialized instruments in the skull and upper vertebrae. Fusion material is also inserted to connect and join the two structures together and form a single structure. Few weeks post surgery, the patient is required to wear a cervical brace to limit neck movement. Physical therapy is also recommended.





  • Transnasal Decompression. The surgeon approaches the front of the skull through the mouth or nose, and then he removes the bone. This procedure, which is rarely used, is done on those patients with other skull deformities. 




  • CSF Diversion. Cerebrospinal Fluid Diversion is the treatment of choice when there is a buildup of the CSF within the skull. A tube is implanted to ‘divert’ the fluid to another part of the body, usually to the abdomen. This provides a quick resolution to the increasing intracranial pressure, and patients are relieved immediately after the procedure.



Which Is The Right Treatment For You?


Your surgeon may have already suggested the treatment that is appropriate for you, as Chiari malformations are different for every patient. The doctor chooses the treatment according to your previous medical history, current age, and weight, or medications that you are recently taking. If you are older or have preexisting conditions, traditional surgery may increase your risks.



Some patients may not qualify for the former and are candidates for the minimally invasive approach. If they are, then choosing a Chiari specialist is advisable – someone who has trained specifically for the meticulous procedure. 


Now that these procedures have been laid out to you, you will be more confident to ask any questions or discuss concerns that you may have. Consequently, you are now able to better understand what your health care team will be explaining to you about your procedure. The next thing that you should focus on is your successful recovery. 

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