Intradural and extradural approaches to Chiari malformation

Many children with Chiari malformations do not present significant symptoms and thus do not need treatment. However, when treatment is needed, Cohen Children’s pediatric neurosurgeons are experts, handling the largest volume of these cases in the region. We offer a variety of Chiari malformation treatment options—both intradural and extradural—all of which are highly successful. Since these surgeries can cause discomfort, we have an ongoing study of using a long acting local analgesic to dramatically help with postoperative pain control.

An extradural approach to Chiari malformation is minimally invasive, where a neurosurgeon can simply make a small incision in the bone and open up the blocked passage in the skull opening to be a little bigger. This is known as a bony decompression.

For more complicated cases of Chiari malformation, doctors may need to take a more invasive intradural approach. A surgeon can open up the lining of the brain and expand that area with a patch.

A Chiari malformation (or hindbrain herniation) is when the back of the brain (cerebellum) pushes down through the bottom opening of the skull (the foramen magnum), which is only meant for the spinal cord to pass through. This can sometimes obstruct the flow of cerebrospinal fluid through that opening, which leads to headaches (and spinal cord damage in certain cases). The pain can radiate into the neck, shoulders and hands and can be extremely debilitating. Every time the patient coughs or sneezes, pressure goes up in the brain, and they may get a headache.

The preparation will differ for each treatment technique, and it’s usually minimal. Your doctor will discuss the specifics with you.

In general, minimally invasive extradural approaches lead to faster recoveries and less discomfort. A bony decompression is usually a one-day hospitalization. A slightly longer hospital stay and recovery is expected for patients who undergo intradural treatment.