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UPMC Department of Neurological Surgery Chair, Robert Friedlander, MD, Authors New Review on Chiari Malformation in The New England Journal of Medicine

June 20, 2024

Department of Neurological Surgery chair, Robert M. Friedlander, MD, has authored a new review article on Chiari malformation in The New England Journal of Medicine. The review, titled “Congenital and Acquired Chiari Syndrome” was published on June 19, 2024.

About The Review and Topics of Discussion

Dr. Friedlander’s review provides a thorough discussion of Chiari malformation, focusing primarily on Chiari malformation type 1 (CM1) in adults.

The review examines the pathophysiological mechanisms underlying CM1, and the typical symptomatic presentation that includes headaches, specifically of a suboccipital nature and made worse by inducing Valsalva maneuvers, paresthesia, numbness, or tingling in the hands or feet. Other symptoms can include sleep apnea, tinnitus, difficulty swallowing, and various forms of nystagmus.

Dr. Friedlander’s review also covers optimal imaging protocols for correctly diagnosing these malformations, and the key imaging features clinicians should be mindful of when reviewing patient CT and MRI data.

In the sections on treatment and surgical outcomes, Dr. Friedlander discusses the primary goals of treatment for CM1 – decompression at the cervicomedullary junction along with achieving normal cerebral spinal fluid flow – and how treatment approaches must take into account the specific anatomical characteristics of the patient, the severity of the presentation, and other individualized factors in order to achieve the best possible long-term outcomes.

Dr. Friedlander’s review also generally covers the current state of surgical outcomes for patients, along with information on complications, such as aseptic meningitis and cerebrospinal fluid leaks. The review also notes that while some patients may require reoperation due to insufficient decompression or intradural scarring, surgical intervention generally leads to improvement in symptoms and overall quality of life.

Dr. Friedlander’s review is a valuable resource for physicians dealing with Chiari malformation, offering insights into the latest understanding of its pathophysiology, diagnostic criteria, and management strategies for these complex and clinically challenging brain conditions.

Read the entire text of Dr. Friedlander’s review using the reference link below.


Friedlander RM. Congenital and Acquired Chiari Syndrome. N Engl J Med. 2024; 390: 2191-2198.

Additional Reading

Learn more about Dr. Friedlander and the Department of Neurological Surgery.