Measuring What Matters: Linking Symptoms, Imaging, and Patient Experience in Chiari and Syringomyelia Care

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In this lecture, Dr. Nathan Rowland, focuses on understanding Chiari malformation and related cranio-cervical conditions by first building a clear foundation in anatomy.

Dr. Rowland opens the lecture by sharing his findings while exploring the Bobby Jones Chiari & Syringomyelia Foundation website, emphasizing the importance of education, awareness, and support for not only Chiari and CSF disorders, but healing for all patient groups.

A wonderfully educational talk, Dr. Rowland walks the audience through the basic structure of the skull and cervical spine, explaining how the head connects to the spine through the occipital condyles, atlas (C1), and axis (C2). A major focus was on the ligaments that stabilize this region, highlighting how their redundancy normally provides both strength and flexibility. When these ligaments fail—due to injury, instability, or connective tissue disorders—various pathologies can develop.

He then explains how Chiari malformation is diagnosed, particularly the measurement of cerebellar tonsil descent (commonly the 5 mm rule using McRae’s line). Rowland stresses that relying solely on measurements can be misleading, and that, just as many Chiari specialists would agree, symptoms are just as important as imaging findings. Other radiographic measurements (e.g., Chamberlain’s line, clivo-axial angle, Powers ratio, atlanto-dens interval) were introduced to show how clinicians assess cranio-cervical instability (CCI).

Different types of Chiari malformations (Types I–IV) are reviewed, along with associated conditions such as syringomyelia, where cerebrospinal fluid forms cavities within the spinal cord. Dr. Nathan Rowland also covers related structural problems including basilar invagination, retroflexed dens, atlanto-occipital dislocation, and severe deformities, illustrating how they exist along a spectrum of instability and developmental abnormalities.

Chiari and related conditions should be understood not as isolated measurements, but as part of a broader structural and developmental spectrum involving the skull, spine, ligaments, and cerebrospinal fluid dynamics.

This lecture took place at the Medical University of South Carolina on October 16th. (2025)