Chiari malformations in adults: their surgical and nursing management

Abstract

There are two categories of Chiari malformations that occur in adults: type 1 and type 2. Type 1 Chiari malformations are conditions where the bottommost parts of the back of the brain (called the cerebellar tonsils) descend below the skull and enter the spinal canal—the space around the spinal cord. In type 2 Chiari malformations, more of the brain descends below the skull. This means that, as well as the cerebellar tonsils, the lower section of the brainstem (the medulla) and the brain's lowermost fluid-filled cavity, the fourth ventricle, also descend. The descending structures cause pressure and disrupt the normal flow of fluid that circulates in the brain and spinal cord, known as cerebrospinal fluid (CSF). This article further explains the Chiari malformations, presents theories of how they are caused and describes their symptoms and complications. It also discusses Chiari malformations, theories of causation, symptoms, complications, treatment and nursing management considerations.