A Chiari malformation, previously called an Arnold-Chiari malformation, is a condition in which brain tissue extends into the spinal canal. There are 4 main types, but type 1, called Chiari I, is the most common. The headache of Chiari I variant is almost inevitably associated with the classical pressure dissociation cerebrospinal fluid flow around the foramen magnum. Importantly, other causes of headache (syndromic and nonsyndromic) always first need to be actively excluded.

Since the headache of Chiari I may only be ameliorated and not cured by surgical intervention, it is important that the patient is provided with a realistic expectation. Many of the other symptoms may not be improved at all by surgery. The development or presence of a syrinx is a case in which more aggressive management may be required following careful evaluation. However, the presence of a confusing nonsignificant hydromyelia or a persistent central canal needs to be carefully considered and the patient must be advised as to normal variants.

Professor Sait Naderi is giving “Chiari Malformation” lecture, don’t miss it!