Chiari Malformation Surgery (Posterior Fossa Decompression)
In Chiari I malformation, the lower part of the cerebellum (the tonsils) sits below the opening at the base of the skull, crowding the brainstem and disturbing the flow of spinal fluid. Many people with Chiari on imaging have no symptoms and need no treatment. Others have pressure-type headaches, and some develop a fluid cavity in the spinal cord (syringomyelia).
The decision to operate rests on symptoms and the presence of a syrinx — not on how far the tonsils descend. Dr. Daggubati takes a conservative approach and operates when it is likely to help.
Symptoms
- Headache at the back of the head, worse with coughing, sneezing, straining or laughing
- Neck pain
- Dizziness, imbalance
- Numbness or weakness in the arms (syrinx)
- Swallowing difficulty or sleep apnea (brainstem compression)
How it is diagnosed
MRI of the brain and cervical spine; sometimes a CSF flow study (cine MRI).
Treatment options
Without surgery
Observation for asymptomatic Chiari; headache management and physical therapy for mild symptoms.
Surgical options Dr. Daggubati offers
Common questions
My MRI mentions Chiari but I feel fine. Should I worry?
Chiari found incidentally in someone without symptoms rarely needs treatment. A visit to review the scan and confirm there is no syrinx is reasonable; surgery usually is not.
Not sure this is you?
Bring your imaging and your story. A single visit usually clarifies what is going on and which options are realistic. Request an appointment or call (301) 718-9611.