Chiari Malformation in Adults
For many adults living with Chiari malformation, the path to diagnosis is long — and often frustrating. Persistent headaches dismissed as migraines, neck pain attributed to posture, numbness in the hands written off as stress. It is not uncommon for adults with Chiari malformation to spend years seeking answers before arriving at a diagnosis that
finally makes sense of their symptoms.
At Advanced Neurosurgery Associates, we understand the diagnostic journey that many Chiari patients have already been through by the time they reach us. Our neurosurgeons provide expert, individualized evaluation and care for adult patients with Chiari malformation across four New Jersey locations — Rutherford, Jersey City, New Brunswick, and Morristown — with a treatment philosophy grounded in precision, patience, and evidence-based decision-making.
What Is Chiari Malformation in Adults?
Chiari malformation is a structural condition in which brain tissue — specifically the cerebellum, the region of the brain that controls balance and coordination — extends downward through the opening at the base of the skull known as the foramen magnum. This displacement compresses the brainstem, disrupts the normal flow of cerebrospinal fluid (CSF), and can produce a wide range of neurological symptoms.
Type I Chiari malformation is by far the most common form seen in adults. Unlike Types II and III, which are typically identified at birth or in early childhood, Type I is often not diagnosed until adulthood — sometimes in a patient’s 30s, 40s, or even later — when symptoms become pronounced enough to prompt neurological investigation or are discovered incidentally during imaging for another condition.
A small but important subset of adult patients develop symptomatic Chiari malformation following trauma — particularly whiplash-type neck injuries — which can cause a previously silent malformation to become clinically significant.
Symptoms in Adults
Chiari malformation symptoms in adults can be wide-ranging, variable, and easy to attribute to other conditions. This is precisely why it is frequently underdiagnosed or misdiagnosed. The most characteristic symptom is a severe headache at the back of the head that worsens with coughing, sneezing, straining, or physical exertion — a pattern that should always prompt evaluation for Chiari.
Other symptoms adults commonly report include:
- Chronic neck pain or stiffness
- Numbness, tingling, or weakness in the arms or hands
- Balance and coordination problems, or an unsteady gait
- Dizziness or vertigo
- Difficulty swallowing
- Vision disturbances, including blurred or double vision
- Tinnitus or hearing changes
- Sleep disturbances or sleep apnea
- Facial pain or pressure
Symptoms often fluctuate in intensity and may worsen over time. Some adults with confirmed Chiari malformation on imaging remain entirely asymptomatic — and in those cases, treatment is not always necessary. The clinical picture, not the imaging alone, drives our recommendations.
The Role of Syringomyelia
A significant proportion of adults with Chiari malformation develop syringomyelia — a condition in which disrupted CSF flow leads to the formation of a fluid-filled cavity (syrinx) within the spinal cord. Syringomyelia can cause progressive pain, weakness, and sensory loss, and its presence often influences the urgency of surgical intervention. Our team routinely evaluates for syringomyelia as part of every Chiari workup.
Diagnosis
Diagnosis begins with a thorough neurological history and examination. Adults with suspected Chiari malformation undergo MRI of the brain and full spine — the gold standard for both confirming the diagnosis and evaluating for associated conditions such as syringomyelia, tethered spinal cord, or hydrocephalus.
In some cases, specialized CSF flow studies using phase-contrast MRI are performed to assess whether and to what degree cerebrospinal fluid movement is obstructed at the craniocervical junction. This information can be critical in determining whether surgical intervention is warranted and in planning the operative approach.
Medication
At least half of those newly diagnosed with epilepsy will become seizure-free with their first medication—if they take it regularly and as prescribed. The efficacy of these medications of course depends on the type and severity of the epilepsy. In some cases, medication may diminish but not completely control all seizure activity.
Many various types of anticonvulsant (also called antiepileptic) drugs are available. Some patients respond to one drug and some may need more than one. It may take several months before the best drug and dosage are determined. Patients are monitored throughout the medication process via blood tests.
Diet
A ketogenic diet, one which supplies the majority of calories from fat as opposed to glucose, mimics the body’s response to starvation by burning fat for energy. Scientists are not precisely sure why this diet prevents seizures, although it is being studied. Estimates vary from 10-30% of children who try it become seizure free, or almost seizure free. And over half who try it gain a 50% reduction in seizures. The remainder do not respond or are unable to tolerate the diet because of side effects.
Treatment Options
Treatment decisions are always individualized and based on symptom severity, neurological findings, imaging characteristics, and the patient’s overall health and goals.
Observation and Monitoring
Adults with incidentally discovered Chiari malformation and no significant symptoms are often managed with periodic clinical evaluation and repeat imaging to monitor for change over time. Not every Chiari diagnosis leads to surgery.
Pain and Symptom Management
For patients with mild or stable symptoms, medications targeting headache, pain, and nerve-related symptoms can provide meaningful relief while the clinical picture is monitored.
Posterior Fossa Decompression
When surgery is indicated, the standard surgical treatment for adult Type I Chiari malformation is posterior fossa decompression. This procedure involves removing a small portion of bone at the base of the skull — and in some cases, a portion of the first cervical vertebra — to enlarge the space around the cerebellum and brainstem and restore normal CSF flow. In many patients, surgery significantly reduces or eliminates symptoms and prevents further neurological deterioration.
Our neurosurgeons utilize intraoperative neurophysiological monitoring throughout the procedure to continuously assess brainstem and spinal cord function.
Epilepsy Surgery Recovery Time
Can Surgery Cure Epileptic Seizures?
Epilepsy surgery is measured by the level of improvement in seizures and quality of life. Adult studies of epilepsy surgery have shown that seizures can be greatly reduced or totally controlled in some cases, and many can stop AEDs. Pediatric studies also report that the majority of infants and young children show favorable outcomes in seizure control, and can also stop AEDs after surgery.
Success Rate After Epilepsy Surgery
Expert Adult Chiari Care Across New Jersey
If you have been living with unexplained neurological symptoms — or if you have already received a Chiari diagnosis and are seeking a specialist opinion — Advanced Neurosurgery Associates offers experienced, thoughtful care at four convenient New Jersey locations in Rutherford, Jersey City, New Brunswick, and Morristown.
We take the time to understand your full history, interpret your imaging in clinical context, and present you with all available options — surgical and non surgical — so you can make an informed decision about your care.
Chiari Malformation Care Across New Jersey
You deserve answers. If you are experiencing symptoms consistent with Chiari malformation or have received a diagnosis and want expert guidance, contact us today.