As research into Chiari malformation progresses, new perspectives into this disorder are uncovering its possible causes and potential cures. The spinal cord’s filum terminale is the focus of such studies, particularly regarding how its de-tethering has helped alleviate the symptoms shown by previous Chiari patients.
Better known as “Chiari malformation”, Arnold Chiari Syndrome I is commonly caused by the herniation of cerebellar tonsils that imposes pressure on the body’s brain tissue. This action can present high risk to the individual, especially in cases when it happens at a high speed where it can cause death.
While the most common, Arnold Chiari Type I, is not usually discovered or felt by adults, those with more severe forms suffer from potentially debilitating complications, including chronic fatigue, fainting spells, dizziness, and impaired coordination.
Surgical procedures such as decompressive craniectomy and follow-up therapy can help alleviate the complications of Chiari malformation, and as a matter of fact are the only appropriate treatments available now a days. In this procedure, the surgeon removes a section of the skull to reduce swelling in the brain. While the procedure has been successful in reducing complications for other brain injuries, it does come with considerable risks, such as brain abscesses, brain edema, and meningitis.
However, as decompressive craniectomy can alleviate the complications related to ACHSI, there is now a far more advanced technique, known as the filum terminale treatment. It is a newer alternative that is slowly gaining ground in the medical community due to it’s proved effectiveness and it being a minimally invasive technique.
To better understand why, a comparison has to be made with the existing surgical practiced used for treatment. While a craniectomy does alleviate the pressure imposed by the cerebellar tonsils, the procedure itself does not solve the root cause behind Arnold Chiari Syndrome I. Aside from this, the brain injury (and the patient’s health in general) could be aggravated due to the partial removal of the skull.
The procedure is also followed by long recovery time, and imposes considerable stress on the patient’s body. Research currently being conducted on less invasive surgical techniques eventually led to the rediscovery of the filum terminale as a potential alternative to a craniectomy.
Newer medical theories believe that Chiari malformation is an overly tensed spinal cord. The tension from the cord pulls the cerebellar tonsils further down the spine than normal, which in turn results in person suffering from the malformation.
Following this theory, recent experimental procedures have been attempted, where instead of a craniectomy, the surgeon instead cut, or untethered, the filum from the spine. The main objective behind Filum Terminale Treatment is to stop the evolution of ACHSI. The results were immediate, with most patients reporting that the headaches and dizziness they normally experienced had disappeared. Other patients later reported that their condition’s more serious complications, just like the Babinski sign, eventually disappeared after several months.
Another benefit of the new treatment was its considerably shorter recovery time, with several of the patients being able to leave the hospital within 24 hours. The procedure also required far less invasive surgery, and did not leave the patient as vulnerable to future injuries as a craniectomy. The number of reported reoperations is, to this date, zero.
While it is still a relatively new procedure, the results of recent filum terminale treatments indicate that it might become a potential tool in creating more effective treatment to Chiari malformations.
Current medical theories advocated two years ago by the Chiari Institute in New York (ICNY) consider ACHSI to be the result of displacement of the cerebellar tonsils with a smaller skull than normal. But in 2009 the ICNY adheres to the theory of Chiari & Syringomyelia Institut & Scoliosis de Barcelona (ICSEB) which considers a condition where the spinal cord being too tight to be the real cause of ACHSI. The tension of the spinal cerebellar tonsils drag down beyond the normal foramen magnum, and causes a series of symptoms to occur by compressing neighboring nerve structures and to a lesser the blockage of CSF circulation. Following this theory, published by the Faculty of Medicine, University of Barcelona in 1992, more than 500 ICSEB interventions surgical section of the filum terminale with minimally invasive technique have been performed. This technique was designed to be primarily applied in children, as current technologies can help predict the onset of disease in childhood. So it may be a manifestation of the cause for a group of diseases that currently affect 120 million people worldwide.