Chiari Treatment
Treatment for Chiari malformation is mainly surgical. If you have been diagnosed with chiari it is best to ask for a referral to a neurosurgeon to discuss your treatment options. While doing this ask for a CINE MRI (shows the flow of csf fluid) as this may help show whether surgical intervention is required.
With chiari there is no rule for when surgery is warranted though a general consensus seems to be if your developing syringomyelia from your chiari surgical intervention needs to be highly considered. If no surgery is required then treatment is symptom alleviation through pharmaceuticals, and therapy.
If surgery is required it is highly important to do your homework and find the right surgeon. While this is not the most complex surgery you will find it is not the most practiced so its very important to find a surgeon who does these often and not just a general neurosurgeon to get the best results.
The name of the surgery you will have is called Bony decompression of the foramen magnum and you may also need a dural patch.
The bony decompression or just decompression surgery for short is where they remove some of the bone for the foramen magnum (bone surrounding the chiari malformation). Doing this creates more room for the cerebellum stopping compression of the tonsils and letting spinal fluid flow regularly. Sometimes a dural patch is required.
This surgery is in addition to the decompression, they will use a medical patch (either your own, cadaver, or synthetic), split the lining of your brain and put the patch over it to make a bigger area for the dura so there is more room for the cerebellum tonsils to move. Some surgeons also cauterise the tonsils to shrink them back into their correct area. The surgery will be a few hours and be under general aesthetic.
Most surgeons require you to spend a day or so in ICU after the surgery just because of the nature of the surgery. After which you will be released to a general ward where they will keep an eye on you, have a visit from a physio and make sure things are fine. Most people are out between 5-14 days approximately. You will then be realised and given a time frame for when you can get back to certain activities.
This image shows the approximate size and placement of the scar made by the surgeon. The area will be shaved but tends to grow back quickly and is easily covered with a scarf or if your hair is long enough it will cover it unnoticed. Washing of hair will be a bit difficult at first and its a good idea to dry it quickly at first so wet hair dosn't sit against a healing scar. Staples tend to be used and need to be removed about 10 days after surgery. This process does not hurt and can be done at the hospital or your local doctor.
Other non surgical treatments work on minimising symptoms through therapies. This may be the preferable choice as brain surgery is used as a last alternative stop stop progression of symptoms that can lead to paralysis and other issues. Therapies range depending on symptoms, these including physical therapy, pain management, hypnotherapy, natural therapies and many others. These can help alleviate symptoms and manage without surgery. What treatments are used depends on each individual and their condition.