About the Procedure

Houston, Texas - Severe headaches in the lower back of the head are the most common childhood symptom of Chiari malformation, according to Ian Butler, M.D., vice-chairman of the neurology department at Memorial Hermann Hospital and director of the pediatric neurology division at The University of Texas Medical School at Houston. On Wed., March 16 at 5:30 p.m. CST, Butler's colleague, pediatric neurosurgeon Stephen A. Fletcher, D.O., will treat a Chiari malformation during a live, global Webcast from Memorial Hermann Children's Hospital in Houston, Texas.


In Chiari malformations, parts of the cerebellum extend into the spinal canal, increasing pressure and inhibiting the flow of spinal fluid. Two small protrusions at the base of the cerebellum, called tonsils, are normally positioned inside the skull. In the Type I Chiari malformation, the most common and least severe form of the condition, the tonsils extend down into the spinal canal. In more severe forms, additional structures of the brain may migrate downward as well.

"The cerebellar tonsils act like a cork in a bottle. If the cork is too tight, the spinal fluid can't move like it should," explained Fletcher, chief of pediatric neurosurgery at Memorial Hermann Children's Hospital and section chief of pediatric neurosurgery at The University of Texas Medical School at Houston. "Head injuries can cause even more compression and magnify the problem."

After making a vertical incision along the lower skull and upper spine, Fletcher will remove bone from the skull and the first two vertebrae in the neck. He also will make an incision in the dura, or membrane covering the brain, and insert a collagen patch. These measures relieve compression and reduce or eliminate symptoms in most patients.

Physicians once considered the condition rare, but modern magnetic resonance imaging has revealed Chiari malformations to be quite common. While the most common symptom is headache made worse by coughing or straining, adults and children with Chiari malformations may experience dozens of other symptoms, including dizziness, difficulty sleeping, weakness, numbness, tingling and vision problems.

Serving as online moderators during the live Webcast will be Steve Allen, M.D., CEO and Chief Medical Officer of Memorial Hermann Children's Hospital, and Ian J. Butler, M.D. The moderators will receive e-mailed questions from viewers worldwide and relay them to Drs. Butler and Fletcher, who will answer selected, appropriate inquiries during the surgery. Archived streaming video of the procedure will be available for at least one year, and Dr. Fletcher and his team will continue to receive and answer e-mailed questions for one week following the surgery.

The program is third in a series sponsored by Memorial Hermann Healthcare System, giving medical professionals and consumers the opportunity to view cutting-edge surgical procedures live on the Internet from anywhere in the world.


About Memorial Hermann Children's Hospital
Part of the Memorial Hermann Healthcare System in Houston, the 161-bed Memorial Hermann Children's Hospital combines the clinical excellence and technological advances of a full-service, university-affiliated hospital with the special compassion and healing expertise that has distinguished it as one of the finest children's hospitals in the nation. More than 37,000 sick and injured children are treated each year at Memorial Hermann Children's Hospital, which offers a comprehensive range of pediatric specialties, including neurosciences, cardiovascular, neonatalogy, and trauma care. To learn more about Memorial Hermann Children's Hospital, visit www.memorialhermann.org.


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