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What is Chiari I Malformation? 

In this condition, the “cerebellar tonsils” in the back part of the brain extend down into the spinal canal. This may alter the normal flow of cerebral spinal fluid as it moves from the brain and down the spinal cord. Many people with a Chiari I Malformation have a spinal cord cyst (an abnormal collection of fluid). This cyst is called a “syrinx.” This syrinx may also cause symptoms. 


4th Ventricle

Cerebellar Tonsils


Common Symptoms of a Chiari I Malformation

  • Headaches

  • Neck, shoulder or arm pain

  • Weakness or changes in the feeling in your hands, arms, or legs

  • Symptoms that become worse with straining or coughing

Treatment of the Chiari I Malformation

Your doctor may suggest surgery to make room for the cerebellar tonsils. Surgery often improves the symptoms or keeps them from getting worse.

Your neurosurgeon will decide the best method of surgery and will go over this during a clinic visit. After surgery, the normal flow of cerebral spinal fluid (CSF) is restored. Often, the spinal cord cyst will go away in a few weeks or months. 

Before Surgery

You will need to have a physical exam and lab tests that include blood work and urinalysis. Schedule this exam with your primary care provider or with a nurse in our department. Complete this within 30 days of surgery. We may cancel surgery without an updated exam.

  • Contact your insurance company for any referrals you may need.

  • Stop these medicines for two weeks before surgery:

    • Aspirin, Excedrin®, Ascriptin®, and Ecotrin®

    • Vitamins and herbal supplements

    • Plavix®

    • Coumadin® or Warfarin

    • Ibuprofen, Advil®, Motrin®, Nuprin®, and Aleve®

You may use acetaminophen (Tylenol®), if needed.

Please no smoking or exposure to cigarette smoke for two weeks prior to surgery. Smoking delays wound healing. Cigarette smoke contains a poison that lowers the level of oxygen in the blood. 

Please see the HFFY “getting your skin ready for surgery” for pre-op bathing instructions.

After midnight the night before surgery:

  • Do not eat anything.

  • Do not drink any milk or juice with pulp.

  • You may drink clear liquids up until 4 hours before surgery.

You will be called the afternoon before surgery. At this time you will be told what time you need to arrive at the hospital and final details about how to get ready for the next day.

You will sign a consent form that states you understand what was explained to you about the procedure. It also states that you know about the risks and benefits of the surgery.

Do not wear make-up, jewelry, or nail polish o surgery. 

During Surgery

This surgery may take about 3 to 5 hours.

A small amount of hair on the back of your head is shaved. An up and down incision is made from the middle of the neck to the back of your head.

After Surgery

It is best to avoid coughing, lifting, and straining for the next 3 months. If you should become sick with a severe cough during this time, a doctor may prescribe a cough medicine. You and your doctor will decide when you should return to work.

When to Call the Doctor

Call if you have any of the following symptoms.

  • Severe headache

  • Fever greater than 101.5 F

  • Redness, swelling or drainage at the incision site

  • Nausea or vomiting

Phone Numbers 

If you have any questions or need to schedule an appointment, please call pediatric neurosurgery: (608) 263-6420.

After hours, nights, and weekend, call the paging operator (608) 262-0486. Ask for the neurosurgeon on call. Leave your name and phone number with the area code. The doctor will call you back.