Development problems

Chiari malformations are conditions which are usually present at birth, whereby the skull volume is too small for the developing brain, which then protrudes through the hole at the base of the skull called the “foramen magnum”. The cerebellum at the bottom of the brain can protrude through the foramen magnum and restrict the flow of cerebrospinal fluid, producing symptoms.

Chiari malformations are quite common and don’t always produce symptoms, but if there is sufficient blockage to CSF flow then this can cause headaches, and in rare instances, can compress the nerves in the spinal cord to the arms and legs, or cause build-up of fluid in the cervical spinal cord and neurological symptoms (syringomyelia). Treatment can include surgery to widen the foramen magnum if there are significant symptoms, scans and correlating MRI findings.

Sometimes the spinal cord can become swollen with fluid in the middle, causing neurologicalsymptoms such as arm or leg pain, numbness, weakness or bowel/bladder problems. There are many causes for syringomyelia including Chiari abnormalities around the skull base, previous neurological infections, bleeding, trauma, tumours, spina bifida or lumbar spine defects, or hydrocephalus (fluid pressure build up in the brain).

Arachnoiditis is due to adhesions or stickiness around the spinal cord or nerve roots, from previous infection, or bleeding, surgery, Myodil myelograms, CSF leak, or sometimes it can be spontaneous. Treatment depends on the cause and extent of the arachnoiditis, but usually involves medical management. Surgery has a limited role in the treatment of arachnoiditis.