Doctors who Treat Chiari

General
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Chiari Malformation

Doctors Who Treat Chiari

Dr. Mark Souweidane (left) and Dr. Jeff Greenfield, pediatric neurosurgeons at Weill Cornell Pediatric Brain and Spine Center. About the Surgeons
A primary care physician may suspect a Chiari malformation, and may provide a tentative diagnosis. But a patient with a suspected Chiari malformation should always be referred to a neurosurgeon for a confirmed diagnosis and an evaluation. The neurosurgeon will make a recommendation to the patient and family as to what course of treatment is appropriate. (See Surgery for Chiari.)

Experienced neurosurgeons at major brain and spine centers have treated many patients with Chiari and will evaluate each new case carefully before making a recommendation. The best brain and spine centers take a team approach to patient evaluation, and consider input from multiple specialists before making a recommendation. Some of the questions a neurosurgeon might consider before recommending a course of treatment are:

  • Does an MRI scan confirm the diagnosis of Chiari?
  • Does the patient have one or more of the Chiari symptoms that affect everyday functioning?
  • Is the patient in pain?
  • Does the patient have a syrinx (a cyst in the spinal column)?
  • Does the condition show signs of progression?
  • Does the patient participate in sports or other highly strenuous activities?
  • Does the patient have symptoms that might be caused by other conditions?

The neurosurgeon will make a recommendation based on the risk of surgery vs. the risk of not operating. If the patient does not have symptoms and does not have a syrinx, yearly monitoring is often all that's needed.

How to Choose a Neurosurgeon

After a tentative diagnosis of Chiari, the patient's primary care physician may make a referral to a neurosurgeon and/or the patient may seek recommendations from other sources, including former patients. Patients may also want to consult with more than one neurosurgeon to get the broadest perspective on his or her condition. When researching or selecting a neurosurgeon, be sure to consider:

  • Does the neurosurgeon have experience with Chiari?
    Not all neurosurgeons frequently treat patients with Chiari malformation. Be sure to ask how many cases a neurosurgeon has treated, and how many of them had surgery. What were the outcomes in those cases? What complications has the neurosurgeon seen?
  • Is the neurosurgeon associated with a major brain and spine center?
    Patients with Chiari malformation benefit from a team approach, in which neurosurgeons collaborate with other specialists – including otolaryngologists (ENTs), cardiologists, gastroenterologists, and specialists in a variety of brain and spine conditions – before making a recommendation on how to proceed.
  • Does the neurosurgeon respect your individual circumstances?
    Not everyone with Chiari malformation needs to be treated the same way, but they all deserve compassion and respect. The best neurosurgeons demonstrate understanding and concern for each individual patient's circumstances and needs – a Chiari patient and family should feel 100 percent comfortable talking with the neurosurgeon, being sure that all questions and concerns are addressed.
Reviewed by Mark Souweidane, MD
Last reviewed/last updated: July 2011