Chiari Malformation Surgery

scan of chiari malformationThe Chiari malformations are structural abnormalities in the posterior part of the head wherein the cerebellum extends beyond the normal space available to and protrudes into and through the large opening at the base of the skull called the foramen magnum. COA Pediatric Neurosurgery Division Director Dr. W. Jerry Oakes and Dr. R. Shane Tubbs are widely recognized as world authorities in the diagnosis, anatomy, treatment and management of the Chiari Malformation. Drs Oakes and Tubbs have published over 200 papers dealing just with the Chiari malformations and are the senior editors of the recently published monograph “The Chiari Malformations” (2013-Springer). Dr. Oakes was awarded Children’s of Alabama Presidential Scholar award in 2010 for recognition of lifetime achievement in clinical management and study of Chiari malformations and is the holder of the Dan Hendley Chair at Children’s of Alabama. Under his direction Children’s of Alabama was invited to participate in the Park-Reeves Initiative which is the largest privately funded prospective multi-disciplinary study and registry of patients with the Chiari malformation. To date Children’s of Alabama remains the largest enroller of patients for this important registry which reflects that COA remains a national referral center for Chiari malformations. Drs Oakes and Tubbs were recognized by their colleagues at the 2012 American Association of Neurologic Surgeons Meeting when they were invited to give an entitled presentation identified as “Best of the Best” and addressed outcomes from Chiari 1 Decompression Surgery.

 Conditions and Treatments

  • Chiari I malformation surgery
  • Chiari II malformation surgery
  • Hindbrain hernia surgery
  • Syringomyelia surgery

Chiari Malformations FAQ's

  • How big is the incision?

    Typically the incision will begin in the hair line above the back of the neck. It will extend about 2-3 inches.

  • Will they shave my child’s head?

    Every effort is made to preserve hair. the doctor will only remove what is necessary to make the incision. However,  if you prefer a complete head shaving, we can accommodate that request.

  • How long will my child be in the hospital?

    3-5 days. The first night is typically spent in the ICU and then if the patient is stable, he\she will be moved to a regular hospital room. Discharge from the hospital is based directly on the patient’s condition. Patient’s must be nausea free, drinking and moving about before discharge.

  • Will this cure my child’s headaches?

    Most patients notice a difference within a day or two of the surgery. Headaches should improve and/or resolve completely over time after this operation.

  • When can my child resume regular activity?

    We allow at least two weeks of recovery before returning to school. Physical activity is usually allowed within another 2-4 weeks depending on the patient.

  • Will there be much pain?

    The first night is typically the most painful. Pain often is related to movement of the neck. While in the ICU, patients can have IV pain medication. Most patients make the transition to over the counter pain relievers such as Tylenol or Ibuprofen by the second day. The most frequent complaint from Chiari surgery is that of nausea and vomiting. We will order additional medication to help with that if needed.

Sub-specialty interest
Jerry Oakes, MD

Links
The Park-Reeves Syringomyelia Research Consortium

Publications

Tubbs RS, Beckman J, Naftel RP, Chern JJ, Wellons JC 3rd, Rozzelle CJ, Blount JP, Oakes WJ. Institutional experience with 500 cases of surgically treated pediatric Chiari malformation Type I. J Neurosurg Pediatr. 2011 Mar;7(3):248-56.

Adeeb N, Mortazavi MM, Shoja MM, Tubbs RS, Oakes WJ, Rozzelle CJ. A
single-center experience with eccentric syringomyelia found with pediatric Chiari I malformation. Childs Nerv Syst. 2012 Nov;28(11):1937-41.

Markunas CA, Tubbs RS, Moftakhar R, Ashley-Koch AE, Gregory SG, Oakes WJ,
Speer MC, Iskandar BJ. Clinical, radiological, and genetic similarities between patients with Chiari Type I and Type 0 malformations. J Neurosurg Pediatr. 2012 Apr;9(4):372-8.

Chern JJ, Gordon AJ, Mortazavi MM, Tubbs RS, Oakes WJ. Pediatric Chiari
malformation Type 0: a 12-year institutional experience. J Neurosurg Pediatr. 2011 Jul;8(1):1-5.

Oakes WJ. Chiari malformation Type I. J Neurosurg. 2011 Sep;115(3):645;discussion 645-6.

Proctor MR, Scott RM, Oakes WJ, Muraszko KM. Chiari malformation. Neurosurg Focus. 2011 Sep;31(3):Introduction.