Chiari and Craniocervical Instability: Evolving Insights and Current Surgical Concepts

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Dr. Patricia Sullivan explains how she and the neurosurgical team at Brown University evaluate and treat cranio-cervical instability (CCI), atlanto-axial instability (AAI), Chiari malformation, and basilar invagination. It highlights how abnormal movement of the dens and surrounding structures can narrow the foramen magnum and compress the brainstem, producing symptoms such as dizziness, pain, or neurologic deficits. The speaker reviews key imaging tools—upright MRI, CT, dynamic CT, CTA, and flexion-extension X-rays—and how findings like pannus formation, auto-fusion, vertebral artery anatomy, clivo-axial angle, and syringomyelia influence diagnosis and surgical planning.

The discussion emphasizes that not all abnormalities require surgery and that conservative treatments (physical therapy focused on stability, Botox, pain-management injections, medications) are effective for many patients. When surgical fixation is necessary—such as C1–C2 fusion or occipito-cervical fusion—the surgeon must balance benefits with long-term limitations, including reduced head rotation, potential swallowing challenges, and hardware-related discomfort. Overall, the talk highlights the complexity of these disorders and the careful, individualized evaluation needed to choose the safest and most effective treatment.

This lecture was presented virtually on October 24th in a three part series including lectures from Dr. Petra Klinge, Dr. Konstantina Svokos, and a Q&A. (2025)

View the other videos here:
Dr. Konstantina Svokos -
Dr. Petra Klinge -
Q&A -