Chiari and Cranio-Cervical Disorders: Surgical Management and Integrated Approach
Introduction
Chiari Malformation and cranio-cervical disorders such as Craniocervical Instability (CCI) and Atlantoaxial Instability (AAI) often coexist in complex patients, especially those with connective tissue disorders like Ehlers-Danlos Syndrome (EDS). Our clinical specialty focuses not only on recognizing these overlapping conditions but on treating them with precision surgery and multidisciplinary care.
Dr. Vicenç Gilete, with over 25 years of neurosurgical experience, leads Europe’s only clinic exclusively dedicated to this type of advanced surgical intervention.
Surgical Treatment of Chiari Malformation
Chiari Malformation Type I can require surgical intervention when symptomatic compression of neural structures is confirmed. Our preferred technique is posterior fossa decompression, performed with neuromonitoring and patient-specific protocols.
The procedure typically involves:
- Suboccipital craniectomy
- Laminectomy of C1 (if required)
- Duraplasty with advanced materials
Each surgery is tailored to the patient’s anatomical findings and symptom correlation. Many of our patients travel internationally to undergo surgery at Teknon Medical Center, a JCI-accredited facility known for its patient safety and surgical excellence.
Surgical Management of CCI and AAI
When Chiari Malformation is associated with Craniocervical Instability (CCI) or Atlantoaxial Instability (AAI), surgical fusion may be required to stabilize the junction between the skull and upper cervical spine.
In these cases, the procedure involves:
- Occipitocervical fusion (C0-C23)
- Atlantoaxial fusion (C1-C2)
- Customized fusion using titanium hardware
- Bone graft augmentation with allograft
Our team is trained in minimally invasive techniques that reduce blood loss, minimize soft tissue damage, and shorten recovery time.
“I had a C0-2 fusion and have made a steady recovery ever since. Last month I jogged 5km, something I thought I’d never do again. Dr Gilete and his team were compassionate, efficient and made me feel as safe as possible. I owe them my life.” — Ella, UK
Comprehensive Diagnosis for Complex Patients
Our specialty lies in detecting what other systems overlook. Standard imaging often misses dynamic instability or tethered cord syndromes, especially in supine positions. That’s why we use:
- Upright CBCT with 3D reconstructions
- Prone lumbar MRI with AI-enhanced clarity
- Advanced morphometric analysis (CXA, Grabb, BDI, BAI)
This enables us to fully map the functional and structural deficits behind the patient’s symptoms, allowing for more targeted and effective surgical planning.
Post-Surgical Follow-up and Rehabilitation
Recovery doesn’t end with surgery. At Promohealth, our team ensures comprehensive post-surgical care including:
- ICU and neurosurgical monitoring at the hospital
- Tailored rehabilitation protocols
- Regular follow-up imaging and virtual check-ins
Patients are provided with a detailed recovery roadmap. Many remain under our follow-up for months after surgery to ensure long-term success and symptom resolution.
Who Are Our Patients?
We primarily assist individuals who:
- Have confirmed or suspected Chiari Malformation with neurological symptoms
- Show signs of CCI or AAI on imaging or clinical exam
- Suffer from complex syndromes like EDS, Marfan, or post-viral syndromes
- Have been previously misdiagnosed or dismissed by general neurology
- Failed posterior fossa decompression patients (previous Chiari decompression)
Patients come from across Europe, North America, and beyond. As Dr. Gilete often says, “We treat patients that no one else dares to understand.”
Frequently Asked Questions (FAQs)
What is the difference between Chiari Malformation and CCI/AAI?
Chiari involves downward herniation of the cerebellar tonsils that should not be confused with tonsillar ectopia, very typical in EDS patients, while CCI and AAI refer to instability at the junction of the skull and upper cervical spine.
When is surgery needed for Chiari or CCI/AAI?
Surgery is indicated when symptoms are severe, progressive, and correlate with radiological findings and/or neurophysiologicalinvestigations that suggest neurological compromise.
Can Chiari, CCI, and tethered cord coexist?
Yes. It is common for patients—especially with EDS—to present with overlapping diagnoses that require integrated diagnostic and surgical planning.
What makes your clinic different?
We are the only center in Europe fully specialized in these disorders, offering expert diagnosis, advanced imaging, and customized surgical care led by Dr. Gilete.
Final Thoughts
Chiari Malformation, CCI, and AAI are often misunderstood, underdiagnosed, or inadequately treated by general practice. Our team provides a highly specialized approach combining state-of-the-art imaging, minimally invasive surgery, and compassionate, personalized care.
If you are seeking surgical answers for Chiari or cranio-cervical instability, we invite you to contact our team or submit imaging for evaluation.
Let us help restore your quality of life with clarity, compassion, and surgical precision.
Reviewed and approved by Dr. Vicenç Gilete, MD, Neurosurgeon & Spine Surgeon | May 20, 2025