Doernbecher Children's Hospital

Chiari Malformation

OHSU Doernbecher offers advanced care for the diagnosis and treatment of Chiari malformation.

  • We offer complete, team-based care with a range of pediatric specialists. They will carefully assess whether your child needs careful monitoring or could benefit from surgery. 
  • Our pediatric neurosurgeons are leaders in treating Chiari malformation. This includes expertise in a less-invasive technique for appropriate patients.
  • We provide advanced coordinated care for related conditions such as hydrocephalus and spina bifida.

Understanding Chiari malformation

Chiari malformation is a disorder in which part of the brain extends into an opening in the base of the skull. Normally, the brain’s cerebellum and brain stem sit in a cavity at the lower back of the skull, and only the spinal cord goes through the opening.

If the cavity is too small, usually because of an anomaly present at birth, part of the brain can be pushed down through the opening. This can cause symptoms by disrupting the flow of cerebrospinal fluid, or CSF, the liquid that cushions the brain and spinal cord against injury.

Types

This is by far the most common type, with part of the cerebellum dipping into the spinal canal.

In this type, the cerebellum and brain stem extend through the opening and into the spinal canal. This type occurs in patients with spina bifida, a birth defect in which the backbone and spinal canal don’t fully close during fetal development.

These types are severe but very rare. In Chiari III, parts of the brain push into the spinal cord. Chiari IV involves abnormal brain development.

Symptoms

Symptoms vary widely, depending on the type and severity. Sometimes the disorder has no symptoms, and the condition is found only after an MRI scan for an unrelated condition.

Common symptoms include:

  • Headaches
  • Dizziness 
  • Pain in the neck, shoulders and back 
  • Problems with feeding and swallowing 
  • Problems with balance and walking 
  • Numbness and tingling in hands and feet 
  • Vision problems
  • Sleep apnea (breathing interruptions during sleep)  
  • Bladder problems

Comprehensive care

The pediatric specialists at OHSU Doernbecher Children’s Hospital are experts at determining which patients need only careful monitoring and which could benefit from surgery. The goal of surgery is to treat symptoms by relieving pressure and restoring the proper flow of CSF.

If surgery is recommended, our pediatric neurosurgeons are leaders in a less-invasive method that is an option for some patients. A study conducted at Doernbecher and published in Neurosurgery¹ showed that children with the less-invasive surgery received similar symptom relief with less risk of complications. They also spent less time in surgery and less time in the hospital.

In addition, our neurosurgeons have access to the latest in high-definition imaging for precise diagnosis and treatment. They work with a team of pediatric specialists who will provide your child with complete care from diagnosis through treatment and follow-up.

Related conditions

Doernbecher offers the most advanced care for conditions that often accompany Chiari malformation.

Because Chiari malformation can block the flow of CSF, it can cause hydrocephalus, the buildup of fluid and pressure in the brain. Our pediatric neurosurgeons offer world-class expertise in treating hydrocephalus, including a minimally invasive technique that avoids use of a shunt in many patients.  

Doernbecher has one of the nation’s few integrated pediatric spine clinics, offering complete care for spina bifida. In addition, our Spina Bifida Program has Oregon’s only comprehensive clinic for ongoing care, helping patients reach their full potential.

  • Our neurosurgeons have particular skill in assessing and treating tethered cord, a condition in which the spinal cord abnormally attaches to tissue in the spinal canal. 
  • Our neurosurgery clinic and comprehensive pediatric spine clinic offer the latest treatment and technology for syringomyelia, a fluid-filled cyst in the spinal cord that can develop when Chiari malformation disrupts the flow of CSF. They also offer advanced treatment for spinal curvature such as scoliosis and kyphosis.

Learn more

¹ “Dura Splitting Decompression for Chiari I Malformation in Pediatric Patients: Clinical Outcomes, Healthcare Costs, and Resource Utilization,” Neurosurgery, June 2013, Zachary N. Litvack, Rebecca A. Lindsay, Nathan R. Selden

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