Twenty-four-year-old Kellee Hearne had suffered severe headaches from the age of 10. Over the course of those 14 years, several physicians diagnosed her with migraines, but none of the medications they prescribed eliminated the pain.
It was her Ob/Gyn who first suggested that the location of the headaches indicated they might be something other than migraines and referred her to a neurologist, who ordered an MRI. Based on the results, he diagnosed her with Chiari I malformation, a neurological disorder in which the cerebellum – the part of the brain that controls balance – descends out of the skull and into the spinal area.
Normally, the cerebellum and parts of the brain stem sit in an indented space at the lower rear of the skull above the foramen magnum, a funnel-like opening to the spinal canal. Chiari malformation is diagnosed when part of the cerebellum is located below the foramen magnum.
The most common Chiari malformation is Type I, which involves the extension of the lower part of the cerebellum into the foramen magnum, without involving the brain stem. Chiari I can affect adolescents and adults, and often causes severe symptoms.
Hearne’s mother learned about the Mischer Neuroscience Institute’s Face Pain, Trigeminal Neuralgia and Chiari Clinic during an Internet search. The clinic was started by Dong Kim, MD, director of MNI and professor and chair of the Vivian L. Smith Department at The University of Texas Health Science Center at Houston (UTHealth) Medical School.
Type I Chiari can be asymptomatic, but patients may also experience neck pain, muscle weakness, numbness, balance problems, vision problems or difficulty swallowing, in addition to headaches.
When Hearne and her mother saw Dr. Kim at the clinic, they discussed surgical options and what to expect during recovery. “They left the decision up to me, but I’d already decided on surgery because I wanted to be here for my 2-year-old son,” Hearne says.
When working with patients, Dr. Kim listens carefully to their descriptions of their symptoms. “It’s most important to correlate the clinical picture and what the patient is feeling with what we’re seeing on MRI,” he says.
“There’s no effective long-term treatment for Chiari malformation other than surgery. Eventually, as the symptoms worsen, medications begin to fail.”
Hearne’s surgery took place on June 20, 2012. “It’s a straightforward procedure,” Dr. Kim says. “The goal of surgery is to provide more space in the foramen magnum without affecting the brain. We open the skull and cut a window in the dura, the outermost of the three layers of meninges surrounding the brain and spinal cord. To prevent a postoperative cerebrospinal fluid leak, we’re now using a synthetic membrane that we carefully sew in under a microscope to ensure a watertight seal.”
Like most patients who undergo the surgery, Hearne was hospitalized for three days and returned to work four weeks later. “Everyone made me feel at ease, from the doctors to the nurses to the nursing assistants,” says Hearne. “Dr. Kim is amazing. He has totally changed my life. The headaches and pain are gone. I feel very blessed and thankful.”
“The most important thing is to seek early treatment,” says Dr. Kim, who does approximately 25 Chiari I malformation repairs every year. “The longer patients endure their symptoms, the most likely they are to have at least some residual symptoms after the surgery.”