Objective:

We aim to conduct this retrospective study to compare surgery and conservative treatment’s demographics, clinical presentations, and interventions for CM-1 patients in a tertiary hospital in Jordan.  

Background:

Chiari malformation type 1 (CM-1) is a congenital anomaly associated with herniation of tonsillar pillars due to abnormality in hindbrain. Standard practice in treatment of (CM-1) is surgical decompression or conservative observation. 

Design/Methods:

We reviewed our hospital’s patients’ clinical records, Brain MRI, and surgical assessment notes for CM-1 patients who presented to our hospital for the period between 2000 to 2022.  

Results:

We identified 37 patients with (mean age) of (26.5 +/- 19.77) years old and a female predominance n=21 (56.75%). Most patients were incidentally diagnosed or presented without symptoms n=22 (59.45%). Out of the 37 patients identified n=7 (18.9%) underwent surgery while n=30 (81.1%) were treated conservatively. Patients who underwent surgery were older in age compared to those who did not with a (mean age +/- S.D.) of (33.00 years +/- 16.5) and (25.03 +/- 20.40), respectively (p=0.08). Surgery was associated with worsening of symptoms compared to observation 57.14% vs 13.33% (p=0.01). Females were as likely to undergo surgery compared to males 19.04% vs 18.75% (p=0.98). Headache was the initial presentation in n=15 (40.50%) of the patients, other common presentations include: cranial nerve deficits n=20 (54.05%), neck and back pain in n=8 (21.62%), and gait abnormalities n=4 (10.81%). 

Conclusions:

Chiari malformation type 1 is a medical condition with a wide array of clinical presentations that is hard to diagnose. Optimum treatment for CM-1 and its association with symptoms alleviation needs further investigation.