Treatment of Anomalies (Malformations)

Arnold Chiari

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More information about the diagnosis can be found at the link ARNOLD CHIARI'S ANOMALY
As a result of surgical treatment, most complaints and symptoms regress in the early postoperative period, and the person returns to a functionally full life, provided that the operation has not developed irreversible atrophic changes.

The first operation in Ukraine for an Arnold-Chiari anomaly in an adult was performed in our clinic of subtentorial neurooncology in 1995 (after training Dr. Fedirko VO in Canada). The number of operations exceeded several hundred, and the effectiveness of the operation on the regression of symptoms is at the level of 94-97%.
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There are 4 most common symptoms of Chiari anomaly:
  • a headache of a pressing nature in the nape, which is enhanced by physical exertion and cough, often with pain in the neck;
  • difficulty of swallowing;
  • weakness and decreased sensitivity in the limbs;
  • violation of coordination and balance.
This condition can remain asymptomatic for a long time. It can manifest in adolescence during a period of active growth or in adults. In this case, there is a whole list of symptoms that may indicate this anomaly:

– the headache usually begins with the occipital region;

– dizziness;

– pain in the neck;

– numbness in the hands

– abnormal sensations in the fingers;

– awakening in the middle of the night due to numbness of the hand;

– feeling of lack of air;

– pressure behind the sternum;

– constipation.

Symptomatology can differ in different patients and does not necessarily correspond to the degree of wedging of the tonsils of the cerebellum. Some patients with significant levels of tonsillitis do not have any symptoms. In turn, patients with a slight incidence may experience severe symptoms. When symptoms are present, they are often fuzzy, blurred and nonspecific, and as a result, Аrnold Chiari anomaly can’t be diagnosed for a long time. The appearance of symptoms is a consequence of a disturbance of the cerebrospinal circulation and compression of the nervous structure. In some cases, damage to the head or neck as a result of trauma can trigger the onset of the disease.

Arnold Chiari Syndrome can be characterized by signs similar to other diseases. This leads to erroneous diagnosis and postpones the correct treatment.

Diagnoses that are often confused with the anomaly of Chiari:

  • cervical osteochondrosis;
  • vertebrobasilar insufficiency;
  • fibromyalgia;
  • chronic fatigue syndrome;
  • migraine;
  • multiple sclerosis;
  • mental disorder;
  • depression;
  • trigeminal neuralgia.
Some patients wait for years, while it is possible to establish the correct diagnosis “Arnold Chiari Syndrome”, because there is no specific pathognomonic criterion for confirming the Chiari anomaly in addition to visualizing the diagnosis. Usually, the diagnosis is established on the basis of a comprehensive assessment of patient complaints, objective and neurological examination data, as well as MRI signs of pathology:

  • wedging of the tonsils;
  • bone deformation;
  • violation of liquor circulation;
  • hydrocephalus;
  • cyst in the spinal cord s sringomyelia (hydromyelia);
The main methods for diagnosing the disease “Arnold Chiari Syndrome” are:

MRI is a non-invasive method that allows you to assess the state of the brain, spinal cord and the system of liquor circulation. Also MRI allows you to assess the degree of wedging of the tonsils of the cerebellum, which can reach the level of C1-C2 cervical vertebrae. The level of tonsillitis is measured in millimeters below the large occipital foramen. At the same time, the degree of wedging observed with MRI scans does not always exactly match the severity of the neurological symptomatology. Sometimes the patient without a wedge of tonsils according to MRI shows marked symptoms, and in a patient with the descent of tonsils reaching 20 mm, the manifestations of the disease are minimal.

CT scan. It is used to visualize the bones of the base of the skull and vertebral column, but it is not informative for the diagnosis of Arnold-Chiari.
Therapeutic tactics depends on the type of malformation and the severity of the symptoms of Arnold Chiari’s syndrome.
Thus, the degree of anomaly is differentiated depending on the displacement of the cerebellar tonsils in the grete occipital foramen, disturbances in the position of the brainstem and the correlation of the structures of the craniocervical junction:
the 1st degree. It appears in adolescence or in adults, and according to statistics the peak of symptoms in adults falls on 40-50 years, which has not yet been explained.
anomaly arnold kiari 2 degrees, 3 degrees. Is manifested in early childhood or adolescence.
Anomaly of the arnold kiari of the 4th degree. It leads to the fact that newborns with such a diagnosis are not viable and die in the first days or weeks after birth.

If the symptoms are mild or moderate, the following may be effective:
  • a certain way of life;
  • proper nutrition;
  • drug therapy.
When the patient has an anomaly of Arnold Chiari, we diagnose in him that the amygdala of the cerebellum is shifted downward into the large occipital foramen. At the same time, the medulla oblongata receives pressure, and this leads to neurological disorders. In the case of severe symptoms or progressive deterioration of the patient’s condition, surgical treatment is required to remove part of the occipital bone and part of the dura mater. This leads to the elimination of compression of the brain structures and the creation of space for the cerebellum and brainstem.

According to literature data and in our experience, the best treatment results are observed when patients are operated on during the first 2 years after the beginning of symptoms. Asymptomatic patients can be observed and operated later if they have symptoms. But it is important to remember that the changes, as a consequence syndrome and hydromia, are growing slowly, and patients often do not pay attention to them until gross manifestations appear. At the same time, already developed violations of the function, as a rule, are irreversible, therefore, the operation should be aimed at preventing their development. As a result of surgical treatment, most of the complaints and symptoms regress in the early postoperative period. A person returns to his functionally full life, provided that irreversible atrophic changes did not develop before the operation.
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When applying to our clinic, it is desirable to have:

MRI scans, doctor's opinion, tests

Doctor of Medical Sciences, head of department
Work experience: 32 years
Candidate of medical sciences, Doctor-neurosurgeon
Work experience: 34 years
Doctor of Medical Sciences, Doctor-neurosurgeon
Work experience: 26 years

Work experience: 12 years


Sholina Ksenia
4 years have passed, and our whole family remembers with the same trepidation the miracle that the dear Vladimir Olegovich did for us. When everyone refused, he took and saved my life ...
Bilda Valentyn
I would like to thank my savior, Fedirko Vladimir Olegovich and the entire team for the removal of subtentorial neurooncology. Separately, I thank my guardian angel, Oksana, who did not leave me, day and night.
Kutovaya Elena
Low bow to all the medical staff, especially Vladimir Olegovich Fedirko. In 2012, my mother was operated on with a diagnosis of trigeminal neuralgia. We arrived in Kiev without even a referral and Vladimir Olegovich heard us and appointed the day of the operation.
Maltseva Victoria
Our family is truly grateful to Vladimirovich Olegovich and the entire team of the clinic for their professional work. Behind this familiar "thank you" is actually an ocean of our and my mother's hopes, worries, fears, sleepless nights ... We have never regretted our decision. Thank you.
Andriychuk Viktoria
Thanks for the golden hands and invaluable knowledge to Vladimir Olegovich Fedirko, as well as to the entire team of the clinic! After a successfully and professionally performed surgery in 2014, this year I became a mother!
Institute of Neurosurgery
The Clinic of Subtentorial Neurooncology of the Institute of Neurosurgery was founded in 1988 as a subdivision of the Department of Neurooncology of the Institute of Neurosurgery named after A.P. Romodanova
Best Neurosurgeons
Every year the clinic staff performs more than 500 complex operations at a modern, highly professional level
Complex Operations
Treatment of neurosurgical diseases of the posterior fossa, brainstem, craniobasal localization, cranial nerves and other complex localizations
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After treatment, our patients remain under supervision for life.
When applying to our clinic, it is desirable to have:

MRI scans, doctor's opinion, tests

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