Complex Chiari Malformations: Diagnosis, Evaluation, and Treatment

Vijay M Ravindra; Douglas L Brockmeyer

doi:10.1016/j.nec.2022.08.009

Complex Chiari Malformations: Diagnosis, Evaluation, and Treatment

Neurosurg Clin N Am. 2023 Jan;34(1):143-150. doi: 10.1016/j.nec.2022.08.009. Epub 2022 Nov 3.

Authors

Vijay M Ravindra¹, Douglas L Brockmeyer²

Affiliations

¹ Department of Neurosurgery, Naval Medical Readiness Training Command, San Diego, CA, USA; Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA; Department of Neurosurgery, University of California San Diego, San Diego, CA, USA.
² Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA; Division of Pediatric Neurosurgery, Intermountain Primary Children's Hospital, Salt Lake City, UT, USA. Electronic address: neuropub@hsc.utah.edu.

PMID: 36424054
DOI: 10.1016/j.nec.2022.08.009

Abstract

The term "complex Chiari malformation" (CCM) refers to a subset of clinical and radiographic findings that describe a subpopulation of Chiari patients with craniocervical kyphosis and secondary brainstem compression. These patients are at a greater risk for unsuccessful surgical treatment with standard Chiari surgical decompressive procedures and may require craniocervical fusion and/or odontoid resection. This article reviews concepts related to the diagnosis, management, and treatment of CCM and discusses possible directions for future research.

Keywords: Basilar invagination; Chiari malformations; Clivoaxial angle (CXA); Complex Chiari malformation (CCM); Condylar-C2 sagittal vertical alignment (C-C2SVA); Retroflexed odontoid.

Publication types

Review

MeSH terms

Arnold-Chiari Malformation* / diagnostic imaging
Arnold-Chiari Malformation* / surgery
Brain Diseases*
Decompression, Surgical / methods
Humans