In this section...

  1. Acute Physiotherapy
  2. Cheshire and Merseyside Rehabilitation Network (CMRN)
  3. Chiari malformation and syringomyella
  4. Cognitive neurology
  5. Complex regional pain syndrome (CRPS)
  6. Dietetic Services
  7. Electroencephalogram (EEG)
  8. Endoscopic (keyhole) spinal surgery
  9. Epilepsy
  10. Epilepsy specialist nurse service
  11. Epilepsy surgery
  12. Essential tremor - Ultrasound thalamotomy
  13. Evoked potentials (EP)
  14. Facial pain
  15. Fluroscopy
  16. Functional Neurological Disorders Service (FNDS)
  17. Headache service
  18. Hydrocephalus, CSF disorders and spina bifida
  19. Infection prevention and control
  20. Integrated Neurology Nurse Service
  21. Interventional Radiology
  22. Major Trauma service
  23. Motor neurone disease
  24. Multiple sclerosis
  25. Multiple sclerosis (MS) nurse service
  26. Nerve conduction studies (NCS) and Electromyography (EMG)
  27. Neuroanaesthesia and Critical Care
  28. Neurogenetic disorders
  29. Neurological long-term conditions OT service
  30. Neurological Long Term Conditions Physiotherapy Team (LTC)
  31. Neurology
  32. Neuromodulation for Pain and Pelvic Floor Instability
  33. Neuromuscular disorders
  34. Neuromyelitis optica
  35. Neuro-Oncology Department
  36. Neuropathic pain (nerve pain)
  37. Neurophysiology Department
  38. Neuropsychiatry
  39. Neuropsychology Department
  40. Neuropsychology inpatient service
  41. Neuroradiology
  42. Neuroscience Laboratories
  43. Neurosurgery
  44. Neurovascular surgery and intervention
  45. Pain Management Programme
  46. Pain medicine
  47. Palliative care pain
  48. Parkinson's disease Nurse Specialists
  49. Pre-operative Assessment Team
  50. Physiotherapy botulinum toxin service
  51. Rehabilitation
  52. Research
  53. Respiratory Physiotherapy Team
  54. Speech and Language Therapy
  55. Spinal surgery
  56. Surgical management of chronic pain
  57. Surgical, Medical, Acute Response Team (SMART)
  58. Theatres
  59. Therapies Department
  60. Tissue viability
  61. Trauma Therapy Team

Chiari malformation and syringomyelia

 

Chiari malformation

Chiari (previously called an Arnold-Chiari malformation) malformation is an abnormality of the posterior fossa (back of the skull) and top of the spine. There are different types. 

A Chiari involves the protrusion of the lowest part of the back of the brain (the cerebellar tonsils) into the top of the spinal canal and may be caused by the brain in this area being too big for the skull. This may cause no symptoms or may cause severe headaches that are often worse on coughing or sneezing. 

Chiari II and III malformations are associated with spina bifida (a congenital condition that may be associated with hydrocephalus and abnormalities at the base of the spine).  

 

Syringomyelia

Syringomyelia is a condition in which fluid filled cavities form within the spinal cord and can lead to pain, and loss of function (weakness or numbness). Some patients with a Chiari I malformation will develop a syrinx. Syrinxes can also occur after a spinal cord injury, meningitis, surgery, or if there is a tumour present. A syrinx is always caused by something else, and treatment is usually directed at the cause of the syrinx, rather than the syrinx itself.

The underlying cause of the problems may relate to alterations in the person’s normal fluid dynamics leading to pressure, blockage of flow, and in the cases of syringomyelia, damage to the spinal cord tissue itself. 

 

Treatment

The treatment of Chiari malformations and syringomyelia can be difficult and may involve operating at the back of the head to enlarge the bony space, endoscopic third ventriculostomy (a fluid bypass procedure), placing drainage tubes (shunts) in the fluid spaces in the head or syrinx, exploring the spinal cord and enlarging the space available for fluid to flow, and untethering the spinal cord.

The Walton Centre has a number of surgeons with an interest in the treatment of patients with these conditions. 

There is a monthly specialist syringomyelia clinic where new patients or patients with complex Chiari or syringomyelia issues can be seen by up to three of the surgeons. 

Imaging of the complete neuroaxis, with flow studies where appropriate is routinely used to assess patients. Intracranial pressure monitoring can also prove helpful in deciding on the best treatment. Outcomes are examined with the spine tango database. 

 

Leaflets

Chiari malformation

 

Consultants

Professor Andrew Brodbelt