eMedicine Specialties > Radiology > Pediatrics

Chiari II Malformation: Follow-up

Author: Lutfi Incesu, MD, Professor, Department of Radiology, Ondokuz Mayis University School of Medicine; Chief, Neuroradiology and MR Unit, Department of Radiology, Ondokuz Mayis University Hospital, Turkey
Coauthor(s): Anil Khosla, MBBS, Assistant Professor, Department of Radiology, Section of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Veterans Affairs Medical Center of St Louis; Michael R Aiello, MD, Radiologist, St Elizabeth Medical Center, Utica, NY
Contributor Information and Disclosures

Updated: Oct 15, 2009

Intervention

Knowledge of the potential life-threatening symptoms of Chiari II malformation has resulted in the advocacy for early surgical intervention, especially in infants. Conservative treatment may lead to irreversible changes. Early recognition of the Chiari malformation is important because it is the leading cause of death in patients treated for myelomeningocele.

Neonates do more poorly with surgery. In one study, 23% died and 16% had a poor outcome. The reason may have been a delay in surgery with resultant brainstem infarction and hemorrhage. However, if surgery is needed, earlier intervention may result in a better prognosis.23,24

Medicolegal Pitfalls

  • Failure to diagnose a Chiari II malformation and its associated anomalies in a neonate or a child can cause serious brain and spinal complications.
  • Failure to identify early cranial and spinal cord lesions may result in delayed intervention and permanent neurologic deficit.
  • Failure to make the correct diagnosis (eg, cerebellar tumor instead of Chiari II malformation) can cause morbidity and mortality resulting from surgery.

Special Concerns

  • US can be performed in high-risk pregnancies, and with a careful US examination, the Chiari II malformation can be diagnosed antenatally.
    • US is routinely used during the antenatal period as a screening method. With careful examination, cranial and spinal pathologic changes related to Chiari II malformations in the fetus can be seen. Reportedly, a lacunar skull can be detected by using US in the fetus.
    • To confirm the diagnosis and gain detailed information, MRI can be used antenatally.
  • MRI has been used as a diagnostic tool during the antenatal period, allowing the intrauterine diagnosis, and even treatment, of spina bifida.
 


More on Chiari II Malformation

Overview: Chiari II Malformation
Imaging: Chiari II Malformation
Follow-up: Chiari II Malformation
Multimedia: Chiari II Malformation
References
Further Reading
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References

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Keywords

Chiari II malformation, neural tube defects, Arnold-Chiari malformation, meningomyelocele, hydrocephalus, Cruveilhier-Cleland-Chiari malformation, Chiari I malformation, Chiari III malformation, Chiari IV malformation, hindbrain anomaly, posterior fossa, myelomeningocele

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Contributor Information and Disclosures

Author

Lutfi Incesu, MD, Professor, Department of Radiology, Ondokuz Mayis University School of Medicine; Chief, Neuroradiology and MR Unit, Department of Radiology, Ondokuz Mayis University Hospital, Turkey
Lutfi Incesu, MD is a member of the following medical societies: American Society of Neuroradiology and Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Anil Khosla, MBBS, Assistant Professor, Department of Radiology, Section of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Veterans Affairs Medical Center of St Louis
Anil Khosla, MBBS is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Neuroradiology, North American Spine Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Michael R Aiello, MD, Radiologist, St Elizabeth Medical Center, Utica, NY
Michael R Aiello, MD is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, American Medical Association, Radiological Society of North America, Society of Breast Imaging, and Society of Cardiovascular and Interventional Radiology
Disclosure: Nothing to disclose.

Medical Editor

Charles M Glasier, MD, Professor, Departments of Radiology and Pediatrics, University of Arkansas for Medical Sciences; Chief, Magnetic Resonance Imaging, Vice-Chief, Pediatric Radiology, Arkansas Children's Hospital
Charles M Glasier, MD is a member of the following medical societies: American College of Radiology, American Society of Neuroradiology, Radiological Society of North America, and Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Marta Hernanz-Schulman, MD, FAAP, Professor, Radiology, Radiological Sciences, and Pediatrics, Director, Department of Pediatric Radiology, Radiologist-in-Chief, Director, Department of Diagnostic Imaging, Vanderbilt University Medical Center, Vanderbilt Children's Hospital
Marta Hernanz-Schulman, MD, FAAP is a member of the following medical societies: American Institute of Ultrasound in Medicine and American Roentgen Ray Society
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

James G Smirniotopoulos, MD, Professor of Radiology, Neurology, and Biomedical Informatics, Chairman, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences
James G Smirniotopoulos, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Head and Neck Radiology, American Society of Neuroradiology, American Society of Pediatric Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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