Arnold–Chiari Malformation: Advanced Diagnosis and Treatment at KG Hospital, Coimbatore

Introduction

Arnold–Chiari Malformation (Chiari Malformation) is a structural disorder affecting the posterior fossa and hindbrain—the region that includes the cerebellum, pons, and medulla oblongata.
This condition disrupts the normal flow of cerebrospinal fluid (CSF) and can cause the cerebellar tonsils to herniate through the foramen magnum, the natural opening at the skull base.

Depending on the severity, associated abnormalities such as hydrocephalus, syringomyelia, syringobulbia, and spinal dysraphism may occur.

Among the various types, Chiari Type I Malformation is the most common and mildest form, often discovered incidentally during MRI scans. It is identified when the cerebellar tonsils extend more than 5 mm below the foramen magnum.

Case Reports – Successful Chiari Malformation Surgeries at KG Hospital

Case 1

A 32-year-old female presented to the Neurology Department at KG Hospital, Coimbatore with hoarseness of voice, difficulty swallowing, occipital headache, and neck pain.

Clinical findings:

Right 6th nerve palsy
Reduced gag reflex
Right 12th nerve palsy

MRI findings confirmed Chiari malformation with syringobulbia. The patient underwent Foramen Magnum Decompression (FMD) with arachnoid band excision, tonsillar cauterization, and lax duraplasty using fascia lata.

Post-surgery, swallowing difficulty and voice quality improved remarkably within days.

Case 2

A 23-year-old male reported neck pain, paresthesia over the right shoulder, and sleep-related breathing difficulty.

Examination revealed:

Dissociated sensory loss over the right neck and shoulder (cape distribution)
Wasting of the right deltoid muscle

MRI showed cerebellar tonsillar descent with extensive syringomyelia (C2–D2).
He underwent Foramen Magnum Decompression, Tonsillar Cauterization, and Lax Duraplasty.

Postoperative outcome: The patient experienced marked symptom relief and continued recovery during follow-up visits.

Understanding Chiari Malformation

Causes and Pathophysiology

The exact cause of Chiari Malformation is multifactorial, involving genetic, mechanical, and hydrodynamic mechanisms. The leading theory attributes it to a reduced posterior fossa volume, causing the cerebellum to shift downward.

Contributing factors:

Congenital posterior fossa hypoplasia
Acquired cranial deformities
Genetic mutations (chromosomes 1 and 22)

The resulting CSF flow obstruction leads to pressure imbalances and the formation of syrinx cavities, which compress the spinal cord and brainstem.

Epidemiology

Chiari I Malformation occurs in about 0.5% to 3.5% of the population, with a slight female predominance. Symptoms usually appear in teenage years or early adulthood.

Symptoms

The most common symptom is a suboccipital headache and neck pain that worsens with coughing, sneezing, or straining.

Other symptoms include:

Dizziness or vertigo
Blurred or double vision
Difficulty swallowing or speaking
Weakness or numbness in limbs
Dissociated sensory loss
Gait imbalance or ataxia
Sleep apnea due to brainstem compression

Diagnostic Evaluation

MRI of the brain and cervical spine is the gold standard for diagnosis.
It identifies:

Descent of the cerebellar tonsils (>5 mm)
Reduced posterior fossa space
Presence of syringomyelia or syringobulbia

Cine MRI can further evaluate CSF flow dynamics, guiding treatment planning.

Surgical Treatment at the Best Neurosurgery Hospital in Coimbatore

At KG Hospital, our goal is to restore normal CSF flow, relieve neural compression, and prevent neurological deterioration.

Standard Surgical Procedure – Posterior Fossa Decompression (PFD)

Suboccipital craniectomy – removes bone to enlarge the foramen magnum.
C1 (and sometimes C2) laminectomy – decompresses the brainstem.
Dural opening to inspect and expand space.
Dissection of arachnoid adhesions to improve CSF circulation.
Duraplasty – enlargement using fascia lata or synthetic graft.
Tonsillar cauterization, if required, to reduce herniation.

Follow-up MRI at 3, 6, and 12 months ensures proper decompression and syrinx resolution.

Early surgical intervention—within two years of symptom onset—is associated with the best neurological recovery.

Prognosis and Outcomes

With timely diagnosis and expert management, Chiari I Malformation has an excellent prognosis.
Patients typically experience:

Relief from headaches and neck pain
Improved swallowing and speech
Gradual recovery of limb strength and sensation

Long-standing nerve damage may take longer to heal, depending on preoperative condition.

Why KG Hospital is the Best Neurosurgery Hospital in Coimbatore

At KG Hospital, we combine advanced technology, multidisciplinary expertise, and compassionate care to treat complex neurological disorders like Chiari Malformation.

Our Neurosurgical Excellence

Highly skilled neurosurgeons: Dr. S. Rajkumar, Dr. T.C.R. Ramakrishnan, and Dr. R. Senthilkumar
Advanced MRI and neuroimaging facilities for precise diagnosis
Microneurosurgery and minimally invasive techniques for safer outcomes
Dedicated Neuro-ICU and rehabilitation support
Proven success in Foramen Magnum Decompression and spinal decompression surgeries

Our Brain and Spine Surgery Unit continues to achieve world-class outcomes, establishing KG Hospital as the best neurosurgery hospital in Coimbatore and a trusted centre of excellence in South India.

Book an Appointment

If you or your loved one experiences persistent neck pain, headaches, or balance issues, early evaluation is crucial.
Consult the expert neurosurgeons at KG Hospital, Coimbatore, for accurate diagnosis and personalized treatment.

📞 Call: +91-422-4042121
🌐 Visit: www.kghospital.com