Surgery for Arnold Chiari Malformation
Surgery For Arnold Chiari Malformation And Trigeminal Neuralgia

Dr. Ghaly comments:

Arnold Chirari Malformation, named after the doctor who discovered it, is a condition present at birth. There are two types, type I and type II, usually seen in children.

The base of the brain goes through the foramen magnum, a hole in the back of the skull. If this area is not large enough, the brain is squeezed. Normally the base of the brain and the back of the brain remain inside the skull, but with this malformation, the distal part of the brain protrudes, it actually squeezes into the spinal canal in the neck.

The back of the brain has two protuberances, called tonsils. These usually remain in the back of the brain. With Chirari, they descend into the spinal canal into the neck, causing pressure from the crowding.

Type II causes pressure on the brain stem and fluid in the brain, called hydrocephalus. Patients experience headaches, weakness, pain and numbness. Type II includes some congenital anomalies, such as spina bifida.

Type I is also congenital, but symptoms do not begin to appear until the person reaches adulthood. Symptoms include headache, neck pain, pain in the arms and legs, pain and focus issues with the eyes and migraine headaches. Surgical treatment makes room for the nerves and decompresses them. Nerves cannot handle pressure of any kind, so one of the main principals of neurosurgery is decompression.

The surgeon removes some of the bone to make room. It is important to do the surgery early on, before damage becomes permanent. Though this condition is fairly easy to diagnose with a simple MRI, many patients are told they have migraine headaches.

The surgery does not leave any disfigurement. Muscles cover the incision area. Sometimes the surgeon makes a graft to make a space in the dura, or covering of the brain.

Recovery is short, usually only two to three days in the hospital. But healing of the wound is important. Fluid from the brain can leak, so the surgeon takes special care with closing the site