Chiari 1 malformation management: the Red Cross War Memorial Hospital approach

Purpose In this paper, we aimed to review our institutional opinions and experience with Chiari 1 malformation management to determine physician practice and outcomes. Methods Discussion between 3 clinicians about practice preferences and the management of Chiari 1 worldwide. Retrospective review of clinical cases over a 10-year period (2009–2018). Results Although there are some minor differences between clinicians in our practice, our approach is broadly similar. We treat incidental Chiari 1 malformations conservatively, with clinical and radiological surveillance, reserving intervention for patients who develop clinical signs or radiological deterioration. We prefer surgical intervention for patients with typical symptoms or a Chiari 1 malformation with radiological progression. If symptoms are atypical, we prefer surveillance. Our preferred operation is a conservative suboccipital craniectomy with expansion duraplasty and adhesiolysis. Our operative complication rate was low and there was no mortality or major morbidity in our series. Surveillance for incidentally discovered Chiari 1 malformations has been a safe practice in our experience. Conclusion Clinical practice among three clinicians in our institution is broadly consistent. We have a conservative approach to Chiari 1 malformation management and our approach appears to have a low morbidity.