Chiari malformation is a health condition which occurs when lower portion of an individual’s brain descends into the spinal cord. Such a problem is likely to arise during developmental stages of a child. It is observed that, in most cases, it does not create any significant health issues. However, in some cases, it may affect the normal flow of cerebrospinal fluid in brain and spinal area and negatively impact overall functioning of brain which can eventually lead to serious disability. Patients may not be able to perform basic activities independently. Therefore, a proper diagnosis and a suitable treatment are necessary to help chiari malformation patients stay healthy.
Symptoms and Causes of Chiari Malformation
Exact cause of this neurological problem is still not defined. However, medical practitioners reveal that it develops due to abnormal development of child during pregnancy. This might probably occur due to faulty genes. The following list describes general signs and symptoms of Chiari malformation.
● Headaches – Headache is the most common symptom of Chiari malformation. Patients may experience frequent episodes of headaches, especially during sneezing or coughing due to pressure created by cerebrospinal fluid on brain.
● Neck Pain – Patients may experience persistent neck pain due to pressure on spinal cord. In such instances, they should visit a doctor at the earliest.
● Balancing Problems – This health disorder may affect nervous system of patients and result in balancing difficulties.
● Numbness – Patients may experience numbness and extreme weakness in their limbs. They may not be able to perform basic routine activities.
● Eyesight Problems – Patients may face eyesight problems such as blurred vision or double vision. Prompt diagnosis is important otherwise it may worsen over a period of time and lead to partial loss of vision.
● Speech and Swallowing Problems – Patients may not be able to speak and swallow their food properly. Patients should consult a well-trained neurologist on experiencing voice changes and pain while swallowing food.
● Sleep Apnea – This condition indicates an abnormal breathing pattern while a person is asleep. Untreated Chiari malformation may lead to sleep apnea in long run.
Patients struggling with such problems must look out for an experienced neurologist for a suitable medical opinion.
Types of Chiari Malformation
Depending on severity, Chiari malformation is divided into three main types. They are clinically referred to as Chiari malformation type I, type II, and type III.
● Chiari Malformation Type I – This type of Chiari malformation appears when lower portion of brain extends to spinal canal. This condition is not considered to be life-threatening and does not require any aggressive treatment.
● Chiari Malformation Type II – This condition appears when lower portion of brain extends to spinal cord slightly more as compared to type I. It can be comfortably managed by medical supervision and consuming medications.
● Chiari Malformation Type III – This is most severe condition amongst all the types of Chiari malformation. It may lead to several neurological complications. A surgical approach is crucial to treat this type of Chiari malformation.
Diagnosing Chiari Malformation
Respective neurologists may start the diagnosis procedure by conducting a basic medical evaluation. They may ask patients to undergo a complete health checkup to understand their current state of being. In addition to this, they may order the given imaging tests. These imaging tests serve as a pathway to precisely diagnose underlying condition of patients.
● Magnetic Resonance Imaging (MRI) – A magnetic resonance imaging test or MRI is basically a painless medical procedure which scans specific area of patient’s body part and creates its high-quality pictures. In this case, surgeons scan patient’s brain and nearby areas to check the presence of Chiari malformation. This procedure uses a magnetic field and strong radio waves to obtain the desired output.
● Computerized Tomography (CT) Scan – A computerized tomography scan or CT scan is a medical procedure which follows working principle similar to that of an MRI. Instead of radio waves and a magnetic field, this procedure uses x-rays. Patients are exposed to x-rays which generate pictures of affected brain.
Depending on diagnostic reports, neurosurgeons will take further step. They will outline the best possible treatment to help improve patient’s quality of life.
Primary Treatment Options for Chiari Malformation
Treatment will largely depend on patient’s overall health, severity of symptoms, and results of diagnostic reports. The given points state primary treatment options for Chiari malformation.
1. Monitoring – Patients do not require any treatment when symptoms are mild and do not bother their routine life. However, they will be monitored by respective neurosurgeons from time to time. Doctors may ask them to undergo certain imaging tests like MRI scans at regular intervals. It will help the doctors to keep a check on patient’s condition. They may recommend other procedures if they observe any serious abnormality during these monitoring sessions.
2. Pain Medications – Respective neurosurgeons may suggest pain medications if patients experience headaches. Pain medications along with regular health checkups can help patients live a normal life.
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Surgical Approach for Severe Chiari Malformation
Decompression surgery is the main procedure which is used to relieve symptoms of Chiari malformation. In addition to that, respective neurosurgeons may perform some additional procedures for best outcomes.
1. Decompression Surgery for Chiari Malformation – Decompression surgery can considerably reduce the severe symptoms of Chiari malformation. It is mostly performed under general anesthetics. It involves removal of a small portion of spinal canal as well as bone from bottom most area of patient’s brain. It minimizes pressure on patient’s brain and enables normal flow of cerebrospinal fluid.
2. Additional Procedures – In addition to decompression surgery, neurosurgeons may also perform the following procedures.
● Endoscopic Third Ventriculostomy (ETV) – This procedure involves creating a hole in brain cavity for taking out the excess cerebrospinal fluid.
● Ventriculoperitoneal Shunting – This procedure involves taking out excess cerebrospinal fluid with the help of a special device known as a catheter. Catheter is a thin flexible instrument that draws out an excessive amount of fluid that creates pressure on patient’s brain.
● Untethering and Spinal Fixation Procedure – Untethering procedure is performed when spinal cords of patients have dislocated from proper position. It involves separating spinal cord and surgically placing it at required position. After that, spinal fixation may be performed to stabilize patient’s spine to a great extent.
Risks and Complications Associated with Decompression Surgery
The given points elaborate major risks and complications associated with Chiari malformation surgery.
● Severe Infection – Patients may encounter serious infection at operation site. In such instances, an immediate medical help is required.
● Cerebrospinal Fluid Leakage – This is the most common complication associated with decompression surgery for Chiari malformation. However, neurosurgeons are likely to take every possible precaution to minimize this risk.
● Paralysis or Stroke – Sometimes, patients may get paralyzed completely or even experience a stroke.
Patients should discuss regarding potential problems associated with decompression surgery with their neurosurgeons in advance. They should also ask them possible solutions and measures which can reduce the chances of such complications prior signing the consent form.
Recovery Following Decompression Surgery for Chiari Malformation
Patients will strictly need to follow each and every instruction of their neurosurgeons to accelerate recovery process. They may experience pain and weakness for some days following decompression surgery. Neurosurgeons may provide certain medicines and drugs which can help them overcome weakness within a short span of time. In addition to this, they may not be able to drive or perform any physical task including cooking or cleaning until they heal completely. Patients should ask a caregiver or a nurse to help them during the healing phase. They should avoid smoking and eat healthy foods to gain their lost strength. Most importantly, they should attend regular follow-up care sessions for maximizing their quality of life.
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