The cerebellum is an important part of the nervous system and brain. It plays a mediating role in transferring sensations from the spinal cord to the brain. Chiari malformation, also known as cerebellar herniation, occurs when the tonsils in the lower region of the cerebellum protrude into the spinal cord canal. The changes that occur in the cerebrospinal fluid as a result of herniation can cause complaints in the patient. During the herniation process, cerebrospinal fluid continues to accumulate in the brain or spinal cord. The patient may experience headaches accompanied by neck pain, muscle weakness, or numbness and pain. Chiari disease is a condition that is mostly treated by surgical methods.

What is Brainstem Herniation?

     Brainstem herniation is a condition that occurs when the brainstem moves out of its normal position in the skull, typically in the neck area. This displacement can happen in the form of herniation, and can block the flow of cerebrospinal fluid. When this fluid accumulates in certain points, it can push the brainstem even further down.

Diagnosing of brainstem herniation

     Head and neck pain are commonly encountered symptoms in the population. In addition, sleep problems can also develop for various reasons. Therefore, the diagnosis of brainstem herniation will be made by checking some points after eliminating these. In particular, difficulty swallowing, inability to cough or inability to bend forward may indicate brainstem herniation. Brain scans will be done to determine if brainstem herniation is present.

What are the Types of Chiari Malformations?

     Chiari malformations types vary depending on how far the tonsils of the cerebellum descend. They are separated into Type I, Type II and Type III.

Type I

     This type is the most commonly seen type of herniation. It is generally more common in children, but can also be seen in adults. In the development of this type, the back of the skull is damaged and the cerebellum is compressed, causing the cerebellar tonsils to block the flow of cerebrospinal fluid. Type I can also affect the formation of cysts in this cerebrospinal fluid.

Type II

     Type 2 Chiari malformation is a neurological condition where the cerebellum and brain stem protrude through the base of the skull and into the spinal canal. It is typically associated with a condition called myelomeningocele, which is a type of spina bifida. Symptoms may include difficulty swallowing, weakness in the arms or legs, and chronic headaches. Treatment may involve surgery to relieve pressure on the brain and spinal cord.

Type III

     Type 3, which is seen in newborns, is caused by a severe herniation of the cerebellum. After this herniation, a fluid sac develops in the back of the baby’s neck.

Type IV

     Type IV is a condition seen in infants as a result of abnormal development of the cerebellum.

Type 0

     A newly defined type. In this type, there is no problem with the cerebellum, but all symptoms of cerebellar herniation are observed in the patient.

What are the Symptoms of Brainstem Herniation?

     In brainstem herniation, there are general symptoms that patients experience. These can be caused by other diseases as well, so they should be carefully controlled by the doctor. Patients may experience the following symptoms:

• The patient may experience severe increase in head, neck and back pain associated with coughing, sneezing and hiccupping.
• Symptoms may become worse as brainstem herniation progresses. These include difficulties walking, numbness in hands and feet, inability to perform hand skills, difficulty swallowing and dizziness.
• Patients may experience speech disorders.
• Head and neck pain may increase when the patient leans forward.
• Patient may have difficulty distinguishing between hot and cold. Some tissues or heat may not be felt.
• In particular, babies experience irregular breathing.
• Epileptic seizures may be observed.

What Methods Are Used in the Treatment of Chiari Malformation?

     The treatment plan for patients with severe symptoms and requiring urgent intervention for Chiari malformation starts with surgery. Surgery is particularly decided when the accumulation of fluid in the brain increases. In order to eliminate and slow down the complications, the area of the brainstem where it is herniated is expanded during the operation. The flow of spinal fluid is relieved. This way, the fluid will flow into circulation and the brainstem will be able to move more freely in the area where it is pressing. It is important to follow the symptoms and consult the doctor to achieve faster and better results.

     After surgery, the patient is monitored to decide whether another operation is necessary. The circulation of fluid is checked with magnetic resonance imaging. If the results are positive, patients can return to their daily activities from the 10th day after the surgery.