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Chiari malformation and sleep apnea


lthomas521
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According to HealthDay, a study of 16 people with Arnold-Chiari Malformation found that 12 of them had sleep apnea. Eight of the 12 had surgery to relieve compression on the brain stem, which resulted in a significant decrease in sleep apnea episodes.

Here's the link to the article, which unfortunately is not free: http://www.neurology.org/cgi/reprint/66/1/136

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Guest Julia59

There seems to be a debate on weather or not I have actual chiari. My herniation is only 1mm, but I have a small posterior fossa resulting in brain stem compression and a prominant vertebral artery---adding further compression---along with the congenital cervical spine compression.

Unfortunately I have not been able to sleep in the last two sleep studies. The second one was ordered for two nights because during my dozing---or light sleep they already noticed problems. Because of cervical/cranial instability this further aggravates the problems. Did you see the study the the Chiari Institute is doing on Chiari and EDS?

Here is the link to their web site---click on the study on the bottom of the page.

http://www.chiariinstitute.com/

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It would certainly make sense that anything compressing the brain stem would have an affect on breathing. I found a site that discussed chiari, only I sure can't remember where. Oh, a vestibular site...anyway it stated that problems actually caused by chiari are very rare, so we have some unique and exotic people here...Of course there are others who have different terms for all of us, but let's not go there... :) cuckoomorgan

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My friend Dorothy used to have apnea before her first decompression...

just a note though about surgical decompression of Chiari, for those who aren't familiar with the procedure or what Chiari is:

Chiari is a herniation of the brain, where part of it slips out of the base of the skull.

Decompression means that they've opened the skull to make a bigger opening and the close it with a variety of options, such as a plate, or the origninal bone plus bone glue, and graft material, mesh, etc.

Keep in mind too, that of the people personally know who've had the procedure, most have required subsequent procedures to deal with complications, including the need for a shunt to help keep the fluid pressure stable in the brain and spinal cord, and or redo of the decompression for various reasons. Even so, my friends with Chiari (some of whom I met in my neurosurgeon's waiting room over the years) still have done better post surgery that what their lives were like beforehand.

Nina

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Guest Julia59

You can also have brain stem compression without herniation----and sometimes this is worse as it can cause more pressure on the brain stem depending on how blocked the CSF flow is, or if there is cervical/cranial instability. Only the most experienced chiari surgeon will look outside the "herniation" box for other chiari type conditions. I guess it's more referred to as small posterior fossa with blocked CSF flow---or retroflexed odontoid with pannus formation of the odontoid bone at C2 which will add further pressure on the brain stem. Cervical/cranial instability with EDS can lead to cranial settling causing the odontoid bone to invaginate into the skull----thus more pressure on the brain stem.

Yes, Chiari is a difficult surgery for NSGs to perform---even the best of them. Decompression is almost an art to get it right----enough to not require a second---or more surgeries---of shunts ect.

I have read where some surgeries go wrong---or some of the materials used to patch the area where part of the skull is removed are not tolerated well, and they have to go back in and patch with something else.

I have also read where chiari surgery is successful and patients go on with their lives without too many complications. They are relieved of many of their symptoms. Currently there is a study of patients with Chiari and EDS at NIH & The Chiari Institute. EDS can create many complications after decompression surgery. Some people with EDS will have instability at the cervical/cranial junction following surgery on the cervical spine---or the chiari surgery, and it may require fusion of the cranial cervical junction. If it's known the patient has EDS before surgery---this can prevent complications. The surgeon should be experienced with EDS.

Don't quote me on any of this----this is just some of the different things I have learned after being diagnosed with this stuff. Many patients who have serious compression of the brain stem, and little or no herniation will be dismissed by some NSGs----there are only a handful of NSGs who realize brain stem compression is brain stem compression, and it needs to be taken very seriously, because there is usually more abnormalities at the cervical/cranial junction. Some of the NSGs will insist that an abnormal neurological examination is caused by something other then cervical spine stenosis---or chiari---or chiari related conditions, despite a person having definate signs of upper spine, or brain stem compression.

And yes, Chiari, and Chiari related conditions will cause ANS dysfunction. Although I have met some Chiari patients with up to 16mms of herniation not have many ANS dysfunction symptoms. But this is only a couple, as most people I have met with these types of conditions have some form of ANS dysfunction or another.

Julie :0)

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