Chiari I Malformation: We Have Guidelines… Now What?

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The Chiari Clinical Guidelines were published in Neurosurgery in October 2023 to offer recommendations on how to diagnose and treat Chiari I Malformation (CM1). The guidelines are broken down into three chapters: Imaging, Symptoms & Diagnosis, and Treatment. Though this is a great step to quicker diagnosis and better treatment of Chiari I Malformation, it appears that these guidelines provide a framework of both what we know AND what we don't know about Chiari...

Chiari I Malformation can be a complex problem to treat due to variability. Those that recognize this, may also find it NOT surprising that these recommendations were made based on literature evidence that is Level 3, which, unfortunately, is not great. Thus, the recommendations are only Grade C which are not strong. The bottom line is that we need more high-quality, Level 1 research on which to base guidelines and recommendations for diagnosis and treatment of CM1. With that, Dr. Jackson underlines some future directions and goals for those in the clinical and research space.

Do these guidelines affect Dr. Jackson's practice? Not necessarily...

So, why are guidelines important? And what would produce Level 1 evidence or a Grade A recommendation?

Dr. Jackson shares his perspective and insight as to how he, personally, diagnoses and treats (or doesn't treat) his Chiari and syrinx patients. Dr. Jackson addresses numerous surgical techniques outlining the pros and cons of each, whether he uses them or not, depending on his own philosophy and each patient's case.

In this "Era of Personalized Medicine", we need more data, we need to consider other possible underlying conditions, we need new, higher quality literature. Fortunately, the Hopkins Chiari Clinical Research Center is working on that through participation in the Chiari Surgical Success Scale, their own retrospective database and a prospective Chiari registry.

This lecture was given at John Hopkins Hospital on June 25th. (2024)