Treatments for chiari malformation in children

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Contact the Department of Neurosurgery

All of the members of the Center for Head, Neck and Skull Base at Boston Children's Hospital have extensive experience caring for children with Chiari malformation. Our specialists are dedicated to anticipating any complications that your child may experience and developing the best therapeutic plans to manage them.

While no medical procedure is a guaranteed success, surgery for Chiari malformation is one of the most successful operations that pediatric neurosurgeons do and we can be optimistic with the patients and families about its outcome.

What are the goals of treatment?

The overall goals of treatment for type I and type II Chiari malformation are the same:

  • Relieve the pressure on the brain and spinal cord
  • Reestablish normal fluid circulation through and around the area

How is Chiari malformation treated?

During surgery, your child's neurosurgeon attempts to relieve the pressure on thecerebellum, brain stem and spinal cord in order to reestablish normal circulation of the fluid in the area. Here are the typical steps involved:

Because the pressure of the bone is one of the most important causes of the compression, the neurosurgeon removes a bit of bone from the lowest part of your child's skull.

The firm covering of the brain and spinal cord tissues (also known as the dura) are then opened and widened to make space for the fluid to circulate around the area.

To reduce crowding in lower part of the cerebellum, surgeons use electrical forceps to shrink the tissue. This maneuver is safe and causes no neurological damage.

Finally, if your child has a build-up of spinal fluid, we inspect the opening under the cerebellum where the cerebrospinal fluid normally exits to make sure that it is now clear of scar tissue and that fluid can circulate normally through the area. Sometimes, a small tube may be placed into this opening, like a doorstop, to keep it open.

What are the chances that the surgery will treat the build-up of spinal fluid successfully?

The surgery has a high success rate.

  • Virtually eliminated in 50 percent of children
  • Substantially reduced in another 45 percent
  • Stabilized in the remaining 5 percent

Will the Chiari malformation recur as my child grows?

Rarely, a Chiari malformation can reappear in children who were operated on under the age of 6 if their skull bone re-grow and recompress the area, or if there are other associated causes of the malformation.

How long will the surgery take and how long will my child be in the hospital?

Depending on what needs to be done, the surgery and operating time can take from two to four-and-a-half hours. Your child will be in the hospital for approximately four-and-a-half days, including the day of surgery.

What are the immediate aftereffects of the operation?

Your child will typically be awake and talking right after the operation, but will have headache, neck pain and nausea for the next 48 hours. We'll keep your child comfortable with medications to deal with each of these problems. Your child will probably begin to eat and get out of bed one to two days after the operation.

Does my child need head protection after the operation, and will he have any long-term limitations after the surgery?

No head protection is needed, since there are strong and thick muscles at the base of the back of the neck that protect the area. Many doctors allow their postoperative patients to participate in all activities including football, lacrosse, soccer, etc.

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- Sandra L. Fenwick, President and CEO

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