title: The complex Chiari: issues and management strategies.
abstract: "Complex Chiari" malformations may be defined as cerebellar tonsil herniation combined with one or more of the following radiographic findings: brainstem herniation through the foramen magnum (Chiari 1.5 malformation), medullary kink, retroflexed odontoid, abnormal clival-cervical angle, occipitalization of the atlas, basilar invagination, syringomyelia or scoliosis. Patients with "complex Chiari" malformation are different from those with typical Chiari 1 malformation in that their management strategy has a higher chance of including other operative interventions aside from a typical suboccipital decompression. These other operative procedures include odontoid resection and craniocervical fusion. This paper outlines specific scenarios where these other operative procedures must be considered and carried out.
authors.affiliation: Department of Neurosurgery, Primary Children's Medical Center, University of Utah, 100 N. Mario Capecchi Dr, Salt Lake City, UT 84113, USA. douglas.brockmeyer@hsc.utah.edu
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Brockmeyer
mesh_terms: D000293:Adolescent; D001139:Arnold-Chiari Malformation / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009809:Odontoid Process / Q000601:surgery; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology; D013595:Syringomyelia / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome