Chiari 1.5 malformation, or bulbar variant of Chiari I malformation, is a term used in the literature to describe the combination of cerebellar tonsillar herniation (as seen in Chiari I malformation) along with caudal herniation of some portion of the brainstem (often obex of the medulla oblongata) through the foramen magnum. It is considered a progression of Chiari I malformation.
Although it is thought to have a lower incidence than Chiari I malformation, the exact range of its incidence is unknown 2.
Often asymptomatic. Clinical features, if present, may include intermittent neck pain, more on extension of the cervical spine 2.
Chiari 1.5 malformation likely results from a Chiari I malformation combined with a smaller posterior fossa that in turn leads to overcrowding and caudal displacement of the medulla 3.
- congenital: progression of Chiari 1 malformation
- intracranial mass lesion
- lumbar puncture
MRI if the best method for the diagnosis with sagittal T1 WI to assess tonsillar herniation:
- descent >6 mm favours Chiari I malformation and >12 mm suggests Chiari 1.5 malformation
- associated findings may include
Treatment and prognosis
Posterior fossa decompression surgery for relieving any symptoms. Sometimes repeated surgeries are required.
- 1. Tubbs RS, Iskandar BJ, Bartolucci AA et-al. A critical analysis of the Chiari 1.5 malformation. J. Neurosurg. 2004;101 (2): 179-83. doi:10.3171/ped.2004.101.2.0179 - Pubmed citation
- 2. Kim IK, Wang KC, Kim IO et-al. Chiari 1.5 malformation: an advanced form of Chiari I malformation. J Korean Neurosurg Soc. 2010;48 (4): 375-9. doi:10.3340/jkns.2010.48.4.375 - Free text at pubmed - Pubmed citation
- 3. Chiapparini L, Saletti V, Solero CL et-al. Neuroradiological diagnosis of Chiari malformations. Neurol. Sci. 2011;32 Suppl 3 (S3): S283-6. doi:10.1007/s10072-011-0695-0 - Pubmed citation