Treatment

The decision to treat patients surgically requires a detailed consultation between the patient and physician. As a general rule, surgery is not recommended unless one or more of the following conditions is met:

• Evidence of neurological deterioration.
• Progression of symptoms that have become unbearable or disabling.
• MRI evidence of syrinx enlargement.

Surgery is not recommended to prevent problems from occurring in the future because the natural history of Chiari malformation and syringomyelia is incompletely understood.

Over the past three years, Dr. Thomas H. Milhorat and Dr. Paolo A. Bolognese have evolved a patient-specific surgical procedure that employs intraoperative color Doppler ultrasound monitoring. Each step of the operation is tailored to the patient's unique anatomical and physiological findings. The requirements for successful Chiari surgery are:

• Optimal decompression of nerve tissue.
• Reconstruction of normal-sized cerebrospinal fluid (CSF) spaces behind the cerebellum.
• Restoration of normal CSF flow between the cranial and spinal compartments.

Real-time color Doppler monitoring is now used routinely in all of the institute's Chiari operations and provides maximal intraoperative confirmation of the goals of surgery.