What is the best treatment for Chiari malformation?

Question

Hi doctor,

I had an MRI three weeks ago, and they told me there is a Chiari malformation of about 8 mm. I went to a neurologist, but he did not listen to me. I have a constant headache, pressure in my neck and shoulders, and nausea with vomiting daily. I have a problem with swallowing and buzzing in the left ear. I have been going for pain management for the past two years with numerous injections. Currently, I am taking the tablet Percoset 7.5 mg, Tizanidine 12 mg. I have dizziness, my hands and arms tingle, and there is numbness.

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

Tonsillar herniation of more than 5 mm in adults is significant and defined as Chiari type 1 malformation. The usual symptoms associated with this condition are imbalance while walking, cough-induced headache, numbness in the hands, nape of the neck, and weakness in the hands. Many people are not symptomatic.

In asymptomatic people with tonsillar descent more than 5 mm, we usually do CSF (cerebrospinal fluid) flow studies to look at the CSF circulation in the foramen magnum. If the CSF flow is altered, we recommend surgery. If the flow is normal, we observe the patient with periodic clinical exams and imaging. In the images that you have provided (attachment removed to protect patient identity) none of them shows the tonsils. So, I am not able to comment on whether there is a Chiari malformation or not.

I hope this helps you.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

In case if you have headaches and dizziness, I suggest doing an MRI ) with CSF flow study around the foramen magnum. If the flow study shows abnormal CSF circulation, you might need surgery. If the CSF circulation is normal, we will have to keep you on follow-up

Surgery for Chiari malformation is usually straightforward and safe. We remove a portion of the bone at the base of the skull to give more space to the tonsils so that they do not compress the critical structures of the brain.

I hope this helps you.

Thank you.

Answer 3

Hi,

Welcome back to icliniq.com.

I suggest you consult a Neurosurgeon for this problem. A pain management specialist is not exactly the best person to deal with Chiari malformation.

The neurosurgeon is able to examine you clinically, and if needed, the doctor will suggest that you undergo an MRI with CSF flow study. For the pain, you may take over-the-counter pain medications such as Tylenol (Acetaminophen) or Advil (Ibuprofen).

I hope this helps you.

Thank you.