Surgery Solves Mystery Headaches-- In-Depth Doctor's Interview
Michael Seiff, M.D., Chief of Division of Neurosurgery, Sunrise Hospital, talks about Chiari malformation and how to treat it…
What is Chiari malformation?
Dr. Michael Seiff: Chiari malformation is when a portion of the brain that should be maintained inside of the skull actually comes a little out of the base of the skull where the hole is, where the brain stem transitions to the spinal cord.
What causes that to happen?
Dr. Seiff: In the vast majority of cases, it’s because the base of the skull is actually a little too small. During development, the skull grows, and if the base of the skull lags behind the rest of the skull then the volume at the base of the skull can be a little smaller than it should be. That’s what drives a portion of the base of the brain out the hole in the bottom of the skull.
Do some people who have Chiari malformation not know that they do?
Dr. Seiff: Some people have this their whole life and never know it and never have problems from it.
What are the stages of Chiari malformation?
Dr. Seiff: It’s really just Chiari malformation type 1. Types 2, 3, and 4 are different entities, even though they have the same name, and Chiari 1 presents differently, depending on the age of presentation. In a neonate, for example, it can present with difficulty breathing and abnormal sounds during breathing. In a child, it can present with scoliosis, as well as headache with curvature of the spine. In an adult, it can present with a whole host of problems, some of which were not classically attributable to a neurosurgical issue. Over time, we’ve learned that these patients can have problems that while not in the past being attributed to a neurosurgical problem, can in fact be corrected with neurosurgery.
Are a lot of patients that you treat at their wits’ end?
Dr. Seiff: Quite often, they go quite awhile seeing multiple practitioners, and I don’t want to say misdiagnosed, but not appropriately diagnosed, until finally somebody either does the appropriate image or thinks about the right story and then sends them over to me.
What are some of the common misdiagnoses for Chiari malformation?
Dr. Seiff: A lot of times, they’re told that it’s in their head because MRIs or the diagnostic imaging may not be obvious as to what the problem is; they have been told they have fibromyalgia, which is a chronic pain syndrome that affects a lot of the body; they’ve been told they have chronic headaches and migraine headaches which cannot be helped by medications or traditional means, and they develop into these chronic pain type patients who are just miserable.
What would be the difference between fibromyalgia and these symptoms?
Dr. Seiff: The type of pain that a patient has who has fibromyalgia is very similar to the types of pains that a patient with Chiari malformation can have. Not every patient with Chiari malformation has that kind of pain syndrome, but if they do, it can be confused with fibromyalgia.
How do you surgically treat Chiari malformation?
Dr. Seiff: There are basically three stages to the operation. The first stage is to make the hole in the bottom of the skull bigger. Once the hole is enlarged, I then open the membrane which covers the brain stem as it transitions to the spinal cord – that’s called the dura. Once the dura is opened, the cerebellar tonsils, if they are enlarged, I shrink those up, usually with just heat, and then I put a patch on the dura to keep everything nice and loose, and then I close.
Does that give the area room to breathe, basically?
Dr. Seiff: Yes, the brain stem, which is under pressure, is relieved of pressure from the surgery, and by giving it more room, it relieves the symptoms.
How soon does a patient see results from the procedure?
Dr. Seiff: One of the symptoms that a lot of these patients have in common is they chronically feel coldness in their hands and feet for years, maybe even since childhood. One of the first things that I ask them in the recovery room is, ‘How do your hands and feet feel?’ Very, very often, they will tell me, even in the post-operative area, ‘For the first time, my hands and feet feel warm. Doc, this is amazing.’
Does the procedure relieve the patients’ pain?
Dr. Seiff: A lot of the patients have a lot of problems, and many, many of the problems have dramatic improvement, and many of the patients improve very quickly.
Are there risks to this?
Dr. Seiff: There’s risk to any surgery, and this obviously is brain surgery and I’m operating very close to the brain stem, often times on the brain stem, and there can be disastrous complications, but in reality, the chances of having one of those complications is very, very low.
What have been the outcomes in your patients after surgery?
Dr. Seiff: The vast majority of patients have dramatic improvement after the surgery. Some patients improve very rapidly – by the time they go home, they can already feel a significant difference, and they’ll go home typically within two or three days of the surgery. Other patients can take several months to appreciate an improvement, but almost every patient has dramatic improvement following the surgery.
Is Chiari malformation more common in women than in men?
Dr. Seiff: It does happen more in women than men. Chances are that’s because of a genetic issue that may predispose certain patients to this problem, and women have, in general, a smaller posterior fossa than men, so they may be more sensitive if it’s even smaller than it should be.
What are some of the symptoms patients have?
Dr. Seiff: Many patients have multiple symptoms in common. For example, they almost all have a headache. Very many of them have ringing in their ears, swallowing difficulties, coldness, numbness in their hands and feet, tripping, stumbling, bladder control issues – there’s a whole host of things that very many of them have in common. A very high percentage also have short-term memory issues, or recently, they’ve noticed that they’re just not thinking clearly, very forgetful, and those issues as well can improve after this surgery.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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