Testing & diagnosis for chiari malformation in children

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Contact the Department of Neurosurgery

Boston Children’s Hospital, we know that an early and accurate diagnosis of your child’s Chiari malformation is the first step to efficient and effective treatment.

How is Chiari malformation diagnosed?

The diagnostic tests your child might require include:

  • Magnetic resonance imaging (MRI): the main tool in diagnosing Chiari malformations, thisimaging procedure uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of the body’s organ and brain structure
  • If the lower part of your child’s cerebellum (the part of the brain that controls balance, coordination and muscle movement) is displaced by more than 5 or 6 millimeters, your radiologist will typically make a diagnosis of a Chiari malformation. If there are symptoms of headache, other neurological dysfunction, or a build-up of spinal fluid, your child should be assessed by a neurosurgeon to determine if your child needs surgery for the malformation. 

A Chiari malformation has been diagnosed in my child, but there are no obvious symptoms. What should we do? 

Your child should be examined by a neurologist or neurosurgeon to determine if there are any neurological abnormalities. The neurologist will also assess the severity of your child’s malformation.

If the malformation is minimal and there are no symptoms, we do not recommend treatment. If the malformation is pronounced and the child is young, follow-up may be more frequent, both clinically and by MRI.

My child has scoliosis and a build-up of spinal fluid, but feels perfectly fine and has no other symptoms. Does my child need an operation?

If scoliosis is present, its progression to a curve greater than 35 degrees may mean that spinal fusion will become necessary. We try to get surgery done before curves worsen in order to lessen the likelihood of the need for a spinal fusion later on.

I have been told that my child has an occult tethered spinal cord in association with a Chiari malformation and that several operations will be necessary to treat it. Is this true?

A child with a type I Chiari malformation almost never has a tethered spinal cord and we do not believe that such surgical explorations are needed. If your child has a type II Chiari malformation, the tethered spinal cord may occur as a result of spinal fluid build-up (syringomyelia) and not the malformation itself. In these cases, the alternative causes of tethered spinal cord will need to be explored further.

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- Sandra L. Fenwick, President and CEO

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