Arnold-Chiarimalformation, also known as Chiari malformation, is a congenital developmental anomaly in which the cerebellar tonsils extend downward, or the lower medulla oblongata or even the IV ventricle, and protrude into the cervical spinal canal through the occipital foramen, due to an abnormal development of the brain structures in the midline of the posterior cranial recess in the embryonic period. Then, the cerebellar tonsil herniation malformation in the diagnosis and treatment of those problems that often appear in the process? The following is a description of the problems that often occur in subcerebellar tonsil hernia malformation. 1.How is subcerebellar tonsillar herniation malformation (Chiari malformation) treated? Can it be treated conservatively? Is surgery necessary? (1) This disease is usually difficult to detect when there is no onset of symptoms, even if the occasional physical examination found that there are no symptoms or mild symptoms or symptoms are relatively stable and do not progress, you can be conservative observation, mild symptoms can be oral medication, physical therapy, and so on. (2) If the disease becomes symptomatic, conservatism is ineffective, and the disease progresses gradually, or new symptoms appear, seriously affecting life, such as severe numbness, weakness, dizziness, choking cough, etc., surgical treatment should be carried out. (3) Because some doctors or patients do not know enough, some people fail to confirm the diagnosis, delay the condition, the disease and symptoms are more serious, or there are contraindications to surgery, it is difficult to surgery, can only be conservative and comfort treatment. 2, cerebellar tonsillar herniation malformation (Chiari malformation) surgical efficacy? The vast majority of patients with good efficacy, I do my own statistics of nearly 2,000 cases of patients, 81% improvement, no change 12%, failed to prevent the disease from continuing to progress 4%, aggravation of 3%, therefore, the overall efficacy of the surgery is better, analyze the aggravation and ineffective reason may be patients with late treatment, poor neurological recovery, postoperative rehabilitation is not systematic related. 3.What are the surgical risks of subcerebellar tonsillar herniation malformation (Chiari malformation)? Overall surgical risks are small, the book says that they include bleeding, nerve injury, spinal cord injury, infection, etc. Of course, these are relatively general, any surgery has these risks, my statistics are more likely to occur include: postoperative low-grade fever (surgical and repair material reactivity, infection, etc.), headache (repair material reactivity, cervical 1 nerve or posterior occipital nerve irritation pain), cerebrospinal fluid leakage (often occurs when the physical condition of the poor, dura mater weakness), and wound discomfort (wound incision related). Some patients ask whether there is a life-threatening situation, but I can only say that it is extremely low, at least I have not happened, but it has been encountered in other hospitals. 4. How to recover from subcerebellar tonsillar herniation (Chiari malformation)? After surgery, it is recommended to wear a neck brace for 1-3 months, which allows for neck movement, and neurological rehabilitation such as muscle strength rehabilitation can be done if there is rehabilitation available, in addition to hyperbaric oxygen therapy to promote nerve recovery. Acupuncture can be tried, but massage and acupressure are more dangerous and caution should be exercised. 5.Does subcerebellar tonsillar herniation (Chiari malformation) recur? Most of the cases do not recur if decompression is adequate, but recurrence may be related to excessive decompression leading to prolapse of cerebellar tonsils (related to the surgeon’s surgical technique) and adhesion of scar tissue. 6. Can I have a second surgery for Chiari malformation if the first surgery fails? Most doctors are reluctant to operate again because of the increased difficulty, uncertain effect and increased risk of surgery; most patients are reluctant to operate again because of the fear of surgical risk and the fear of surgical efficacy. In my opinion, for patients whose decompression is not sufficient in the first surgery and whose symptoms have not improved, we can consider remedial surgery again. Although the difficulty and risk increase, in the long run, the patient’s nerve damage is gradually aggravated, and the quality of life gradually decreases, and there is a great risk of not having surgery. It mainly depends on the doctor and the patient to jointly assess whether the benefit of surgery is greater or the benefit of conservatism is greater, and it cannot be decided unilaterally. 7. Can subcerebellar tonsillar herniation (Chiari malformation) be cured? This disease belongs to the congenital developmental malformation, surgery belongs to the “corrective” treatment, and surgery has trauma, how to talk about a cure, for example, appendicitis internal medicine infusion can be called a cure, if the conservative ineffective surgical removal of the appendix, can be called a cure? Of course not, although no symptoms, but also no appendix. This disease surgery needs to bite off the bone (destructive), the dura mater needs to be enlarged to repair (similar to mending clothes, but not their own fabric), and the lower herniated cerebellar tonsils are still in the original position, can not be the same as the normal people in the skull, can only say that the treatment is effective or improved, can not be said to be cured, said that the cure of the majority of the doctors do not know or suspected of deception.