Welcome aboard! Take this journey with us through the marvel of the human nervous system, guided by our dedicated tour guide, Ms. Neuro.
Buckle up and prepare to venture from the base of the skull to the tip of the spinal cord, where we'll explore three unique landscapes: Chiari malformations, Spina bifida, and the subtle but significant impact of Syringomyelia.
As we begin our journey, we start right at the base of the skull, where the brain meets the spine.
“Look up,” Ms. Neuro says, “and you’ll see the cerebellum, the part of the brain that coordinates movement and balance. But here’s where Chiari Malformation comes in. In some people, the cerebellum extends down too far, crowding this gateway we call the foramen magnum.”
Imagine this gateway like an underpass that’s a bit too narrow. As the cerebellum herniates downward, it blocks the smooth flow of cerebrospinal fluid (CSF), the brain’s natural cushion and cleaning fluid. This overcrowding creates “pressure waves” that ripple throughout the brainstem and into the spinal cord.
“When there’s no room to breathe,” Ms. Neuro explains, “the result can be headaches, neck pain, dizziness, and balance problems. It’s like traffic piling up at a busy intersection. This pressure sometimes even stretches into the arms and legs, causing numbness.”
Chiari malformations are classified as follows into types based on severity:
Now we move down to where the spine begins. Watch your step as we enter a narrow passage that the brainstem shares with the spinal cord.
We’re about halfway down the spine now, and we notice a small gap—a disruption in the spinal cord’s protective casing. This is the territory of Spina Bifida, a birth defect affecting the spine’s development.
“Unlike Chiari, which crowds from above,” Ms. Neuro explains, “Spina Bifida occurs lower down, where part of the spinal cord doesn’t fully close during fetal development. This leaves the nerves exposed and vulnerable.”
There are different “versions” of Spina Bifida, each like a chapter in the story of the spine.
In spina bifida occulta, the gap is small and might not even be visible. But in meningocele and myelomeningocele, the opening allows the spinal cord or its membranes to protrude through the back. Spina Bifida’s impact on the spine depends on its location and severity. Higher up, it may affect the arms and chest; lower down, it could impact only the legs. When nerves aren’t fully shielded, they may also develop tethered cord syndrome, where the spinal cord gets stuck to nearby tissues, creating painful tension as a person grows.
As we move deeper down the spine, Ms. Neuro points out a thin, dark structure that wasn’t there before—a fluid-filled cavity within the spinal cord itself. Syringomyelia, Neuro explains, often comes as a “companion” to Chiari malformations and tethered cords from Spina Bifida. It is the collection of cerebrospinal fluid (CSF) in the spinal canal, which accumulates over time and expands, compressing the nerves around it and disrupting the signals that travel from the brain down to the spine.
This pressure, Ms. Neuro warns, can lead to more serious symptoms over time—weakness, numbness, and even loss of reflexes.
“Syringomyelia is like a shadow,” Ms. Neuro continues, “often going unnoticed until it’s well-developed. MRI scans can detect these syrinxes early, but treating them is another challenge.”
Dr Arvind Bhateja, the Lead Neurosurgeon at Sparsh hospitals and the Founder of the community Giving Back talks about the difficulties faced in the treatment of Chiari Malformations and Syringomyelia in his recent Instagram video.
Depending on what stage of the disease the patient presents in, the patient prognosis is decided. If the patient has been diagnosed relatively early when the syrinx is not very large, the patient responds well. If the patient presents with a large syrinx and sever neurological deficits like scoliotic bend of the spine, wasting and degeneration, its much more difficult to treat. Do not neglect the patient's symptoms because late treatment can have poorer results.Dr Arvind Bhateja, Lead Neurosurgeon at Sparsh hospitals
A small section of the skull or spinal lamina is removed during Chiari decompression surgery in order to widen the nerve route. For Spina Bifida, early intervention is crucial in the form of surgery during infancy to close the spinal opening and reduce the risk of infection. In cases where Syringomyelia has already begun, a shunt to drain the syrinx is put in which reduces its pressure on nerves. Another fact to note is that treating the deformity in Chiari patients stops syrinxes from developing in the first place.
As our journey ends, Ms. Neuro reminds us that although Spina Bifida, Syringomyelia, and Chiari Malformations each have their own effects, they are all a part of the human body's greater tale. Each step of the way, we learn how these conditions create their own unique challenges, but also how medical interventions can help bring the body back toward balance.
“With the proper support, the spine and brain can continue to do their work—guiding, sensing, and moving—just as they were designed to do,” says Ms. Neuro.
As we leave this fascinating journey, we reflect on the intricacies of the nervous system and the efforts to protect and support it, knowing that each of these conditions may affect the spine differently, yet all share a place in the same interconnected network.
MSM