Chiari Malformation

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Deciding on Treatment for Chiari

A primary care physician may suspect a Chiari malformation, and may provide a tentative diagnosis. But a patient with a suspected Chiari malformation should always be referred to a neurosurgeon for a confirmed diagnosis and an evaluation. The neurosurgeon will make a recommendation to the patient and family as to what course of treatment is appropriate. (See Surgery for Chiari.)

Experienced neurosurgeons at major brain and spine centers have treated many patients with Chiari and will evaluate each new case carefully before making a recommendation. The best brain and spine centers take a team approach to patient evaluation, and consider input from multiple specialists before making a recommendation. Some of the questions a neurosurgeon might consider before recommending a course of treatment are:

  • Does an MRI scan confirm the diagnosis of Chiari?
  • Does the patient have one or more of the Chiari symptoms that affect everyday functioning?
  • Is the patient in pain?
  • Does the patient have a syrinx (a cyst in the spinal column)?
  • Does the condition show signs of progression?
  • Does the patient participate in sports or other highly strenuous activities?
  • Does the patient have symptoms that might be caused by other conditions?

The neurosurgeon will make a recommendation based on the risk of surgery vs. the risk of not operating. If the patient does not have symptoms and does not have a syrinx, yearly monitoring is often all that's needed.