Chiari II malformations are treated if the patient is symptomatic, and physicians have determined that there are no complications from hydrocephalus. In some patients, consideration of a tethered cord is also explored.
In many infants who become symptomatic from a Chiari II malformation, the symptom onset and progression are severe and rapid, and this requires an urgent or emergency approach. Surgical treatment of these malformations depends on the type of malformation.
The goal of surgery is to relieve the symptoms or stop the progression of the syrinx or symptoms. Chiari I malformations may be treated surgically with only local decompression of the overlying bones, decompression of the bones and release of the dura a thick membrane covering the brain and spinal cord or decompression of the bone and dura and some degree of cerebellar tissue resection.
Occasionally some patients will also require cervical spinal fusion. Decompression is performed under general anesthesia. It consists of removing the back of the foramen magnum and often the back of the first few vertebrae to the point where the cerebellar tonsils end.
This provides more space for the brainstem, spinal cord and descended cerebellar components. A tissue graft is often spliced into this opening to provide even more room for the unimpeded passage of CSF. In some patients the descended cerebellar components are debulked or removed.
Occasionally, the cavity within the spinal cord resulting from hydromyelia can be drained with a diverting shunt tube. This tube can divert the fluid from inside the spinal cord to outside the cord, or be directed to either the chest or abdominal cavity. These procedures can be done together or separately.
Chiari II decompression is treated similarly, but is usually restricted to decompressing the tissues in the spinal canal and leaving the back of the skull alone. The benefits of surgery should always be weighed carefully against its risks. Although some patients experience a reduction in their symptoms, there is no guarantee that surgery will help every individual. Nerve damage that has already occurred usually cannot be reversed. Some surgical patients need repeat surgeries, while others may not achieve symptom relief.
Central canal : A small tubular cavity in the center of the spinal cord which is normally not dilated. Cerebellum : The portion of the brain which is in the posterior fossa. It is involved in coordination of movements. Dysraphism : Developmental abnormalities in the midline region of the back, with incomplete fusion or malformation of a seam, such as in all forms of spina bifida.
Foramen magnum : The opening at the base of the skull through which the spinal cord passes. Hydrocephalus : A condition in which excess cerebrospinal fluid CSF builds up within the ventricles fluid-containing cavities of the brain and may increase pressure within the head.
Medulla oblongata : Lowest part of the brainstem, located just above the spinal cord, at the exit from the skull. Provides control for breathing and heart function. Some more extreme cases may require surgical introduction of a shunt that redirects excess CSF out of the brain. The time it takes to fully recover from Chiari decompression varies from child to child, but most patients will typically spend three to four days in the hospital and two to three weeks at home before returning to school.
Patients may experience some intermittent frontal headaches and post-surgical neck pain during recovery, but these usually pass. Most of the children we treat surgically can expect to return to all normal activities and can enjoy just being kids again. Patients and their families travel here for the best available diagnosis, treatment and follow-up care. Search Term.
Menu Button. Recently Visited. View More Results Loading Some children will show signs of a spine syrinx, but others will not. In these situations, an MRI scan may be needed for a definite diagnosis. In children younger than 16 whose spines are still growing, the presence of a syrinx can also be associated with the development of scoliosis, an abnormal, lateral side-to-side curvature of the spine. Toddlers, children and teens with undiagnosed type 1 Chiari malformations may develop headaches, which are typically located at the back of the head and neck, and are often made worse by exertion.
Type 2 Chiari malformations can also be associated with hydrocephalus, a condition in which there is an obstruction of the flow of cerebrospinal fluid that is found inside of the ventricles fluid-filled areas inside of the brain.
Sleep apnea is another problem that occurs in people with a Chiari malformation. This is a serious sleep disorder characterized by brief interruptions in breathing during sleep. A sleep study can confirm the presence of sleep apnea so a doctor can prescribe treatment. If you have no symptoms, the problem may be found when you have imaging tests for other reasons. If you have symptoms, your healthcare provider will ask about your health history and give you a physical exam.
He or she may refer you to a specialist. Imaging tests are done to detect a Chiari malformation type I. Your child may have 1 or more of these tests:.
This test is the one most often used to diagnose Chiari malformations. It uses large magnets and a computer to make detailed pictures of the inside of the body.
CT scan. This test uses a series of X-rays and a computer to create detailed pictures of the inside of the body. A CT scan is more detailed than a regular X-ray. You may be treated by a neurologist or neurosurgeon. These are experts in brain and spinal cord problems. Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is. With no symptoms. Your health may be watched closely. You might not need any treatment if you do not have any symptoms.
If your headaches are severe or you have problems caused by the pressure on your spinal cord such as movement difficulties , surgery may be recommended. Under general anaesthetic a cut is made at the back of your head and the surgeon removes a small piece of bone from the base of your skull.
They may also remove a small piece of bone from the top of your spine. This will help reduce the pressure on your brain and allow the fluid in and around your brain and spinal cord to flow normally.
The aim of surgery is to stop existing symptoms getting any worse. Some people also experience an improvement in their symptoms, particularly their headaches.
However, surgery sometimes results in no improvement or symptoms getting worse.
0コメント