Chiari Malformation

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Doctors Who Treat Chiari Malformations

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.

How to Choose a Neurosurgeon

After a tentative diagnosis of Chiari, the patient's primary care physician may make a referral to a neurosurgeon and/or the patient may seek recommendations from other sources, including former patients. Patients may also want to consult with more than one neurosurgeon to get the broadest perspective on his or her condition. When researching or selecting a neurosurgeon, be sure to consider:

  • Does the neurosurgeon have experience with Chiari? Not all neurosurgeons frequently treat patients with Chiari malformation. Be sure to ask how many cases a neurosurgeon has treated, and how many of them had surgery. What were the outcomes in those cases? What complications has the neurosurgeon seen?
  • Is the neurosurgeon associated with a major brain and spine center? Patients with Chiari malformation benefit from a team approach, in which neurosurgeons collaborate with other specialists – including otolaryngologists (ENTs), cardiologists, gastroenterologists, and specialists in a variety of brain and spine conditions — before making a recommendation on how to proceed.
  • Does the neurosurgeon respect your individual circumstances?

Not everyone with Chiari malformation needs to be treated the same way, but they all deserve compassion and respect. The best neurosurgeons demonstrate understanding and concern for each individual patient's circumstances and needs — a Chiari patient and family should feel 100 percent comfortable talking with the neurosurgeon, being sure that all questions and concerns are addressed.

Meet the Chiari specialists from the Weill Cornell Brain and Spine Center:

Dr. Philip E. StiegDr. Philip E. Stieg, the chairman and neurosurgeon-in-chief of the Weill Cornell Brain and Spine Center, is one of the top neurosurgeons in the nation, having been named one of America’s Top Doctors by Castle Connolly for 13 years in a row. Dr. Stieg has developed an international reputation in the area of cerebrovascular disorders and surgery and specializes in Chiari malformations in adults; his work has been broadly published, and he has contributed to groups such as the Joint Sections of Cerebrovascular Surgery of the American Association of Neurological Surgeons and Congress of Neurological Surgeons (AANS/CNS). (Read more about Dr. Stieg.)

Dr. Mark SouweidaneDr. Mark Souweidane, internationally recognized as an expert in the field of pediatric neurosurgery, is vice chairman of the Weill Cornell Department of Neurological Surgery and director of the Weill Cornell Pediatric Brain and Spine Center. He has been named one of America’s Top Doctors by Castle Connolly, and is regularly included on lists of the nation’s Best Doctors and Super Doctors. A pioneering champion of minimal access neurosurgery, Dr. Souweidane has specialized endoscopic surgical skills that attract patients and practitioners that benefit from his talents. (Read more about Dr. Souweidane.)

Dr. Jeffrey GreenfieldDr. Jeffrey Greenfield is Assistant Professor of Neurological Surgery in Pediatrics at Weill Cornell Medical College and a pediatric neurosurgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. Dr. Greenfield specializes in minimally invasive (endoscopic) pediatric neurosurgery as well as in the treatment of Chiari malformations, spasticity disorders, and hydrocephalus. (Read more about Dr. Greenfield.)

The surgeons and clinical professionals of the Weill Cornell Brain and Spine Center have the state-of-the-art facilities of NewYork-Presbyterian Hospital, the #1 hospital in New York, available to them for their lifesaving work. The combined resources and expertise of the NewYork-Presbyterian/Weill Cornell Medical Center allow us to offer the very best in patient care, with excellent outcomes.

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Reviewed by Jeffrey Greenfield, Ph.D., M.D.
Last reviewed/last updated: November 2012
Illustrations by Thom Graves, CMI