Dr. Bovis describes Chiari malformation to his patients as a lifetime mismatch between the size of the brain and the size of the skull. More specifically, it is present when the size of the posterior fossa, the cavity that houses the back of the brain (cerebellum and brain stem), is smaller than normal. In many cases it is congenital (patients are born with it), but it may also develop after birth. This structural abnormality results in the overcrowding and downward push of the cerebellum and brain stem into a small opening, called the foramen magnum. These structures then put pressure on the spinal cord, impair function and cause disturbances in the flow of cerebral spinal fluid. This is the most common form of the condition and is categorized as Chiari malformation Type 1 (CM1), previously referred to as Arnold-Chiari malformation.
With Type I Chiari malformation, frequently symptoms do not present until adolescence or adulthood. These symptoms include severe head and neck pain; headache aggravated by coughing, sneezing or straining; hand and arm weakness; dizziness and balance difficulties; tinnitus; visual disturbances; spasticity; and difficulty with memory and concentration. Because the symptoms vary from patient to patient and are unspecific, Chiari malformations frequently go undiagnosed. Dr. Bovis has seen many of these patients in his office, who were misdiagnosed and treated for spinal stenosis, disc herniations or fibromyalgia. In other very unfortunate cases, patients were told there symptoms had no structural origin and were therefore untreatable.
Dr. Bovis will use a physical examination, a thorough history and imaging studies to diagnose Chiari malformation. Patients recommended for surgery will typically have clinical symptoms and imaging studies that both suggest Chiari malformation.
Currently, there is no proven medical or non-invasive therapy for Chiari malformation. Dr. Bovis explains, however, that the surgical procedure for Chiari malformation is highly successful. In published clinical studies, more than 80 percent of patients who undergo surgery for Chiari malformations report significant improvement in symptoms and quality of life.
The surgical procedure for Chiari malformation involves enlarging the opening in the back of the skull to relieve the pressure on the back of the brain and creating more space for the normal flow of cerebral spinal fluid. This surgery is essentially a “bone” operation, as no brain tissue is removed or disturbed.
Most patients remain in the hospital for a few days following surgery for Chiari malformation, called posterior fossa craniectomy. Dr. Bovis will discuss the risks of surgery, the post-operative restrictions and other specific details of each patient’s surgery during the pre-operative visit.
Dr. Bovis performs surgery to treat Chiari malformation at Advocate Lutheran General Hospital and Alexian Brothers Medical Center. He also welcomes questions about Chiari malformation. Prospective patients are welcome to call (847) 698-1088 to schedule an appointment.