Information about Chiari and CVJ Disorders

 Click here for a comprehensive review of Chiari and disorders of the craniovertebral junction (CVJ) 

Click here for a list of Chiari and CVJ publications from the Chiari and CVJ Program at the University of Iowa


Chiari and Disorders of the Craniovertebral Junction Program

We have ongoing research programs studying Chiari and CVJ conditions. Please ask us about these and how you can get involved.


Overview of the Program

The University of Iowa Hospitals & Clinics (UIHC) is one of the most experienced institutions in the world treating Chiari and disorders of the craniovertebral junction (CVJ). Over the last 40 years at UIHC, over 6000 children and adults have been treated for Chiari and wide-ranging CVJ conditions and over 800 surgeries have been performed for the most complex type of CVJ and Chiari abnormalities. We have published over 150 publications, numerous book chapters, and some of the most cited papers on the presenting symptoms and treatment strategies for Chiari type I malformation and CVJ conditions.
The University of Iowa Hospitals & Clinics is one of the pioneering institutions in treating Chiari and CVJ disorders. In the late 1970s, Dr. Arnold Menezes perfected the transoral approach, an approach through the back of the mouth to the CVJ. This revolutionized the treatment of Chiari and CVJ pathology. In the late 1970s, the University of Iowa was one of the first institutions to publish and adopt an algorithmic treatment strategy for patients suffering from Chiari and CVJ conditions. This treatment strategy has since been accepted and used throughout the world. Over the last 40 years, we have developed a better understanding of CVJ disorders and established multiple microscopic and minimally invasive approaches to the CVJ by developing new approaches using the endoscope. This has resulted in excellent outcomes and minimal complications. In addition, we have developed and implemented new reduction strategies that have diminished the need to perform approaches through the back of the mouth or through the nose.

We treat each child and adult on an individual basis to provide the appropriate, optimal and tailored treatment strategy. By treating both children and adults with Chiari and CVJ conditions, we have gained significant experience and a better understanding of these conditions. Furthermore, by treating both children and adults, we are able to follow our patients for a lifetime. We have developed a large referral pattern from all over the nation and world due to our  experience in treating these complex conditions.

Surgeries Dr. Dlouhy Performs

          - infants to adults -

Posterior fossa extradural decompression for Chiari malformations
Posterior fossa intradural decompression for Chiari malformations

        and syringomyelia
Posterior fusion for craniovertebral junction instability

Occipital cervical fusion

C1-C2 fusion
Transoral approach (through the back of the mouth)

Extended transoral approaches
Endoscopic endonasal approach (through the nose)


Conditions Dr. Dlouhy Treats

        - infants to adults -

Chiari malformation - all types

Complex Chiari malformation
Basilar Invagination
Basilar Impression
Cranial settling (rheumatologic basilar impression)

Occipitocervical instability or dislocation

     Occipitoatlantal instability or dislocation

     Occipitoatlantoaxial instability or dislocation

Atlantoaxial instability or dislocation

Atlantoaxial rotatory subluxation/dislocation

Atlas or C1 fractures and Jefferson fractures

Axis or C2 fractures and Hangman's fractures

Condylar fractures

Os Odontoideum
Hypermobility syndromes (Ehlers-Danlos Syndrome)

Klippel-Feil Syndrome

Atlas assimilation (occipitalization of the atlas)
Down’s syndrome associated spinal disorders
Achondroplasia associated spinal disorders
Rheumatoid Arthritis associated spinal disorders
Calcium pyrophosphate deposition disease (CPPD) of the spine
Proatlas segmentation abnormalities
Tumors of the clivus, atlas, and odontoid