At Children's Hospital of Philadelphia (CHOP), we know you have options when seeking care for your child. Consider these factors when choosing the care team that’s the right fit for you and your family: 

Specialized expertise: If your child is dealing with the complex symptoms of Chiari malformation, CHOP’s Chiari Clinic has experts who can help. Our specialists are leaders in managing the care of children and teens with this challenging condition.  

Comprehensive, multidisciplinary care: We offer comprehensive clinic visits with our entire multidisciplinary care team on the same day. Our core team includes neurosurgeons and neurologists, with additional supporting care provided by speech and language therapists, physical therapy, neuro-ophthalmologists and sleep specialists. 

Unparalleled diagnostic capabilities: Our patients have access to the highest quality neuroradiology and the highest level of diagnostic testing available. We assess patients thoroughly through physical examination, review of imaging such as MRI and CT, and engagement with the family to identify the right care for each child.   

Dedication to finding the best treatment option: Our team uses the full range of diagnostic tests and a multidisciplinary, collaborative approach to determine the best treatment option for your child. This includes nonoperative therapy, minimally invasive procedures, and surgery to relieve pressure on the brain. This approach allows us to see the patient as a whole.    

Cutting-edge Surgical Options: If surgical intervention is appropriate for your child, we offer the full range of surgical treatment options, including:  

• Extradural Chiari decompression – In this procedure, a neurosurgeon removes a small amount of bone in the back of the skull to create more space and improve spinal fluid flow. This is a lower-risk procedure with a shorter hospital stay, and the outcomes are great. There is usually no need for additional surgery after this procedure. 
• Intradural decompression – In this procedure, a neurosurgeon starts by removing a small amount of bone in the back of the skull to create more space. Then, the surgeon makes an incision in the outer covering of the brain (called the dura) and sews in a patch (called a duraplasty) to create more space to allow for improved spinal fluid flow. 

In rare instances, further surgical intervention is needed for Chiari malformation. These may include: 

• Occipital-cervical fusion – This is a surgery in which screws and bone grafts are used to join the skull and the spine to address cervical instability and prevent injury.  
• Ventral decompression – This surgery is done through the nose or mouth to relieve pressure on brain and spinal cord.  
• Spinal shunting – A spinal shunt is a small, hollow tube placed in the spine to help drain extra cerebrospinal fluid and redirect it to another part of the body where it can be reabsorbed. The shunt remains in the body and is typically connected to the abdomen, where the extra fluid is absorbed.