Definition; It is the abnormality of some parts of the cerebellum outside the normal or extending outside the skull to the upper spinal canal. Although this complex disease has been known since 1883, it is now easier to visualize radiologically thanks to modern diagnostic imaging methods (MR technologies). There are 5,6,7 types of this disease, separately in adults and children. While Type-2 to Type-3 are seen in newborn babies, Type-1 is more common in adults. While it is more common in women than in men, the disease usually occurs between the ages of 25 and 30, while children usually first complain in their 10s. Many theories have been put forward for the formation of primary or idiopathic Chiari malformation (cerebellum sagging), including chromosomes. In secondary cerebellar prolapse (LP), water removal from the waist or placement of catheters into the spinal cord for treatment purposes (lumbo-peritoneal shunts) or tense spinal cord syndrome (traction theory) are among the reasons.
Complaints and symptoms of cerebellar prolapse; Pain (headache, especially headache with cough), neck pain, shoulder and back pain) are common in adults, and they are accompanied by dizziness, loss of balance, and difficulty walking. There are many complaints and symptoms such as disorders, loss of strength and sensation in the arms, difficulty in swallowing, hoarseness, ringing in the ears, heart palpitations, tremors in the hands.
Diagnosis of cerebellar prolapse: in the diagnosis of this disease. In those who complain about a comprehensive neurological examination; MRI examinations of the brain, neck, back and waist regions are the main imaging test method. Sometimes, for differential diagnosis or other accompanying diseases (bone anomalies, scoliosis, low intracranial pressure), computed tomography, brainstem excitation potentials, electrophysiological examinations for spinal cord cysts (syringomyelia), and sleep tests are performed for those with respiratory problems. Spinal cord cysts (syringomyelia) and spinal curvatures (scoliosis) are seen together at a rate of 40-60% in adolescent cerebellar prolapses. In the types of cerebellum prolapses in adults, the tonsils of the cerebellum are >5 mm prolapsed, and in children, those with >6 mm prolapses are considered abnormal. It is accepted.
Treatment of cerebellar prolapse; It should be determined in a very thorough examination whether this disease causes any complaints or not. Painkillers and muscle relaxants are used in medical treatment. Those whose complaints progress in this disease and those who have neurological deficits are very important in deciding on surgical indication. In the decision for surgical treatment of this malformation, the mechanism of the disease and its causes (bone or intracerebral causes) should be analyzed very well. Since most adult Chiari patients are symptomatic patients, if they are symptomatic or complaining, appropriate diagnostic methods are important in the correct surgical decision. Many different surgical techniques are used in the surgical treatment of Chiari malformation. The aim is to remove the pressure on the nerve elements in the cranio-spinal region or to make new restorations for brain water circulation.
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