The Chiari Institute was developed to treat patients suffering from Chiari malformation, a rare structural condition that affects the cerebellum; syringomyelia, a chronic disease of the spinal cord; and related disorders.
The mission of the Chiari Institute is to advance our understanding of Chiari-related disorders through methodical, focused and continuous research. In recent years, the physicians at the Chiari Institute have been responsible for redefining the clinical features of Chiari malformations, introducing color Doppler ultrasonography as a means for visualizing and measuring cerebrospinal fluid flow intraoperatively, developing a tailored, patient-specific technique for Chiari surgery and discovering the genetic basis of Chiari malformations and associated connective tissue diseases. Currently, the Chiari Institute is compiling the largest and most detailed database ever created for the outcome analysis of Chiari surgery.
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The evaluation of patients begins with a detailed clinical questionnaire. A team of nurse practitioners supervises the data entry, scheduling of tests and physician consultations. Our secreterial department assists with housing requests, if available.
Outpatient activities are conducted with a multidisciplinary approach. The detailed diagnostic workup includes six MRIs, C MRIs, dynamic X-rays, 3D CTs, high-definition imaging and morphometrics. These are followed by a screening evaluation by a nurse practitioner with clinical screens for Ehlers-Danlos Syndrome and tethered cord syndrome. Next comes a neurology visit. The diagnostic process culminates with a neurosurgical visit. The final product is a report of at least 11 pages.
The goals of the diagnostic workup are to:
- Establish the correct diagnosis.
- Educate the patient and answer their questions.
- Provide a list of management options.
- Discuss the preferred operative technique if surgery is required.
The development of a multidisciplinary approach to address the medical and surgical needs of patients combined with an active research program has elevated the Chiari Institute to the highest level of international recognition.
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The decision to treat patients surgically requires a detailed consultation between the patient and physician. As a general rule, surgery is not recommended unless one or more of the following conditions is met:
- Evidence of neurological deterioration.
- Progression of symptoms that have become unbearable or disabling.
- MRI evidence of syrinx enlargement.
Surgery is not recommended to prevent problems from occurring in the future because the natural history of Chiari malformation and syringomyelia is incompletely understood.
Since our inception, we have evolved a patient-specific surgical procedure that employs intraoperative color Doppler ultrasound monitoring. Each step of the operation is tailored to the patient's unique anatomical and physiological findings. The requirements for successful Chiari surgery are:
- Optimal decompression of nerve tissue.
- Reconstruction of normal-sized cerebrospinal fluid (CSF) spaces behind the cerebellum.
- Restoration of normal CSF flow between the cranial and spinal compartments.
Real-time color Doppler monitoring is now used routinely in all of the institute's Chiari operations and provides maximal intraoperative confirmation of the goals of surgery.
Read more about the surgeries performed at The Chiari Institute.
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