Skip to main content
SpringerLink
Log in

Surgery for Chiari Type I Malformation

  • Chapter
  • First Online:
Book cover Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals

  • 1521 Accesses

Abstract

Chiari malformations (types I–IV) comprise a spectrum of abnormalities of the craniocervical junction including the brainstem, cerebellum, cervical spine and spinal cord, clivus, and subocciput. The Chiari I malformation (CM-I) is the subject of this chapter. This chapter reviews the relevant anatomy, pathophysiology, symptomatology, diagnosis, operative technique, anesthetic considerations, and neuromonitoring principles of the CM-1. Finally, we provide a case illustration illuminating the challenges of an operation for the CM-1.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    Note: The senior surgeon [R. F. Sekula] prefers his own variation on the classic operation, which includes a limited skin incision [1 in.], limited suboccipital craniectomy and cervical laminectomy, with cerebellar tonsil reduction and expansile duraplasty.

References

  1. Cleland J. Contribution to the study of spina bifida, encephalocele, and anencephalus. J Anat Physiol. 1883;17:257–91.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Carmel PW, Markesbery WR. Early descriptions of the Arnold-Chiari malformation. The contribution of John Cleland. J Neurosurg. 1972;37(5):543–7.

    Article  CAS  PubMed  Google Scholar 

  3. Chiari H. Uber veranderungen des kleinhirns infolge von hydrocephalie des grosshimns. Dtsch Med Wochenschr. 1891;17:1172–5.

    Article  Google Scholar 

  4. National Institute of Neurological Disorders and Stroke. Chiari Malformation Fact Sheet. 2015; Publication No. 13-4839. http://www.ninds.nih.gov/disorders/chiari/detail_chiari.htm

  5. Ellenbogen RG, Armonda RA, Shaw DW, Winn HR. Toward a rational treatment of Chiari I malformation and syringomyelia. Neurosurg Focus. 2000;8(3):E6.

    Article  CAS  PubMed  Google Scholar 

  6. Milhorat TH, Chou MW, Trinidad EM, Kula RW, Mandell M, Wolpert C, et al. Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery. 1999;44(5):1005–17.

    Article  CAS  PubMed  Google Scholar 

  7. Mohammadali MS, Tubbs SR, Oakes WJ. The Chiari malformations. New York: Springer Science + Business Media; 2013. Chapter 4.

    Google Scholar 

  8. Koentges G. Developmental systems biology: deciphering the molecular causes of Chiari I./II. Paper presented at UIC/Conquer Chiari Research Symposium. Chicago: University of Illinois; 2007.

    Google Scholar 

  9. Matsuoka T, Ahlberg PE, Kessaris N, Iannarelli P, Dennehy U, Richardson WD, et al. Neural crest origins of the neck and shoulder. Nature. 2005;436(7049):347–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Chiapparini L, Saletti V, Solero C, Bruzzone M, Valentini L. Neuroradiologic diagnosis of Chiari malformations. Neurol Sci. 2011;32:S283–6.

    Article  PubMed  Google Scholar 

  11. Sekula Jr RF, Jannetta PJ, Casey KF, Marchan EM, Sekula LK, McCrady CS. Dimensions of the posterior fossa in patients symptomatic for Chiari I mal-formation but without cerebellar tonsillar descent. Cerebrospinal Fluid Res. 2005;2:11.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Barkovich AJ, Wippold FJ, Sherman JL, Citrin CM. Significance of cerebellar tonsillar position on MR. AJNR Am J Neuroradiol. 1986;7(5):795–9.

    CAS  PubMed  Google Scholar 

  13. Elster AD, Chen MY. Chiari I malformations: clinical and radiologic reappraisal. Radiology. 1992;183(2):347–53.

    Article  CAS  PubMed  Google Scholar 

  14. Loth F, Yardimci MA, Alperin N. Hydrodynamic modeling of cerebrospinal fluid motion within the spinal cavity. J Biomech Eng. 2001;123(1):71–9.

    CAS  PubMed  Google Scholar 

  15. Raksin PB, Alperin N, Sivaramakrishnan A, Surapaneni S, Lichtor T. Noninvasive intracranial compliance and pressure based on dynamic magnetic resonance imaging of blood flow and cerebrospinal fluid flow: review of principles, implementation, and other noninvasive approaches. Neurosurg Focus. 2003;14(4):e4.

    Article  PubMed  Google Scholar 

  16. Sivaramakrishnan A, Alperin N, Surapaneni S, Lichtor T. Evaluating the effect of decompression surgery on cerebrospinal fluid flow and intracranial compliance in patients with Chiari malformation with magnetic resonance imaging flow studies. Neurosurgery. 2004;55(6):1344–50. discussion 1350–1.

    Article  PubMed  Google Scholar 

  17. Sala F, Squintani G, Tramontano V, Coppola A, Gerosa M. Intraoperative neurophysiological monitoring during surgery for Chiari malformations. Neurophysioslogy. 2011;32:S317–9.

    Google Scholar 

  18. Moller AR. Intraoperativeneurophysiologicalmonitoring, vol. 2. Luxembourg: Harwood Academic; 2006.

    Google Scholar 

  19. Chadwick GM, Asher AL, Van Der Veer CA, Pollard RJ. Adverse effects of topical papaverine on auditory nerve function. Acta Neurochir (Wien). 2008;150(9):901–9. discussion 909.

    Article  Google Scholar 

  20. Smith DS. Anesthetic management for posterior fossa surgery. In: Cottrell JE, Young WL, editors. Cottrell and Young’s Neuroanesthesia. 5th ed. Philadelphia: Mosby Elsevier; 2010. p. 206.

    Google Scholar 

Suggested Reading

  • Anderson RC, Dowling KC, Feldstein NA, Emerson RG. Chiari I malformation: potential role for intraoperative electrophysiologic monitoring. J Clin Neurophysiol. 2003;20(1):65–72.

    Article  PubMed  Google Scholar 

  • Chiapparini L, Saletti V, Solero CL, Bruzzone MG, Valentini LG. Neuroradiological diagnosis of Chiari malformations. Neurol Sci. 2011;32 Suppl 3:S2863–6.

    Google Scholar 

  • Loth R, Yardimci MA, Alperin N. Hydrodynamic modeling of cerebrospinal fluid motion within the spinal cavity. J Biomech Eng. 2001;123(1):71–9.

    CAS  PubMed  Google Scholar 

  • Tubbs RS, Oakes JW. The Chiari malformations. New York: Springer; 2013.

    Book  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neuroanesthesia, Department of Anesthesiology, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA

    Penny P. Liu M.D.

  2. Department of Anesthesiology PGY3, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA

    Chaim I. Nelson M.D.

  3. Department of Neurosurgery, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA

    Gregory D. Arnone M.D.

  4. Charlottesville, VA, USA

    Ashley Kane Palmer

  5. Division of Neurosurgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, 200 Lothrop Street, Suite B400, Pittsburgh, PA, 15213, USA

    Raymond F. Sekula Jr. M.D., M.B.A., F.A.C.S.

Authors
  1. Penny P. Liu M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chaim I. Nelson M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gregory D. Arnone M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ashley Kane Palmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raymond F. Sekula Jr. M.D., M.B.A., F.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Penny P. Liu M.D. .

Editor information

Editors and Affiliations

  1. Departments of Anesthesiology, Neurological Surgery and Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Antoun Koht

  2. Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA

    Tod B. Sloan

  3. Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA

    J. Richard Toleikis

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Liu, P.P., Nelson, C.I., Arnone, G.D., Palmer, A.K., Sekula, R.F. (2017). Surgery for Chiari Type I Malformation. In: Koht, A., Sloan, T., Toleikis, J. (eds) Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals. Springer, Cham. https://doi.org/10.1007/978-3-319-46542-5_28

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-46542-5_28

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-46540-1

  • Online ISBN: 978-3-319-46542-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation