Chiari Malformations

Chiari Malformations are a surprisingly common congenital malformation of the hind brain (bottom of the brain, top of the spinal cord, depending how you want to look at it).  In our practice we review 3-5 patients with Chiaris weekly.  One of the reasons Dr. Trumble took the title of Director of Congenital Neurosurgery was specifically to care for patients with Chiari malformations.

Most Chiari patients have a Chiari I malformation.  The appropriate diagnostic test is a head or cervical spine MRI.  Most patients will respond to medical management of their symptoms.  Therefore, although the only specific treatment for a Chiari malformation is surgery (true to any anatomical abnormality), we want to ensure that maximal medical management has been achieved prior to any surgical intervention.  We are surgeons.  We are trained to operate.  But we want to make sure we will help the patient with an operation.  Using our clinical criteria, <20% of our Chiari patients require surgery. 

Should surgery be required, we personally perform the operation, which takes 1-2 hours.  General anesthesia is used so you are completely asleep during the operation.  The first night or two is spent in the intensive care unit (ICU).  Family is welcome to stay in the ICU should they like.  Patient controlled analgesia is used (PCA), giving the patient a button connected to a computer that dispenses narcotic pain control, giving the patient maximal control of their own pain management.  As soon as you are recovered, able to drink enough we don’t worry about you becoming dehydrated, on oral medications, and able to walk to the bathroom, you will be discharged home.  Typical hospital stay is 3-5 days.

View Dr. Trumble's Chiari Malformations clinical presentation.