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SLIDESHOWS CCI/AAI Neurosurgical management of Hereditary Hypermobility Connective Tissue Disorders Cervical instabilities in the EDS population Recognition of Craniocervical Instability in complex Chiari patients Retethering in Ehlers-danlos syndrome Urological manifistations of Tethered cord syndrome Tethered cord syndrome in Ehlers-Danlos syndrome Tethered cord IJVS + IH

OTHER CONDITIONS COMING SOON

TRANSVERSE SINUS STENOSIS Transverse sinus stenosis refers to the narrowing (stenosis) of the transverse sinus, a large venous channel in the brain responsible for draining blood from the brain toward the internal jugular vein. The transverse sinuses are part of the dural venous sinuses, which are specialized blood vessels within the dura mater (the outermost membrane surrounding the brain) that collect venous blood from the brain and direct it toward the jugular veins. When there is stenosis (narrowing) of the transverse sinus, it can obstruct the normal flow of blood from the brain, potentially leading to increased intracranial pressure and other neurological symptoms. This condition is also referred to as transverse sinus thrombosis if the stenosis is caused by a clot. ANATOMY The transverse sinus is located on each side of the brain and runs along the back of the skull. It collects venous blood from the brain's internal structures, such as the cerebellum, brainstem, and cerebral hemispheres, before draining it into the internal jugular vein. The sigmoid sinus is a continuation of the transverse sinus, leading directly into the internal jugular vein, and from there, blood is returned to the heart. SYMPTOM S The symptoms of transverse sinus stenosis are typically related to impaired venous drainage from the brain, which can cause increased intracranial pressure and reduced blood flow. Symptoms may include: Headache : A common symptom due to increased intracranial pressure. Headaches may be persistent, throbbing, and worse in the morning or when changing position (such as lying down) Tinnitus: Ringing or pulsatile sounds in the ears, often caused by increased pressure in the venous system or impaired venous drainage from the brain Visual Impairment : Blurred vision, transient visual loss, or even blind spots may occur due to pressure on the optic nerves or from papilledema. Neurological Symptoms: Symptoms such as dizziness, nausea, or vomiting due to increased intracranial pressure. In severe cases, neurological deficits like motor weakness, seizures, or cognitive changes may develop. Swelling of the Neck : In some cases, neck or facial swelling may occur due to impaired venous drainage. Cognitive Impairment : Patients with transverse sinus stenosis may experience difficulty concentrating, memory problems, or a general feeling of "brain fog." Seizures: In severe cases of venous congestion or increased intracranial pressure, seizures may occur due to reduced cerebral blood flow. CAUSES Transverse sinus stenosis can result from various conditions, including: Venous Thrombosis Transverse sinus thrombosis is a condition in which a blood clot forms within the transverse sinus, leading to stenosis or complete blockage. This can occur due to various factors, such as: Hypercoagulable states (conditions that increase blood clotting, like certain genetic disorders, cancer, or pregnancy). Infections (e.g., sinusitis or otitis media). Trauma or surgery in the head or neck region, particularly if there is damage to the venous system. Oral contraceptives, pregnancy, or hormone replacement therapy (all of which can increase the risk of clotting). External Compression: Tumors, cysts, or enlarged lymph nodes around the neck and base of the skull can compress the transverse sinus, leading to narrowing and reduced venous outflow. Atherosclerosis: Although less common in veins, atherosclerotic plaques can form in the venous system and contribute to stenosis of the transverse sinus. Idiopathic Intracranial Hypertension (IIH): Also known as pseudotumor cerebri, IIH is a condition characterized by elevated intracranial pressure without an identifiable cause. The high pressure can lead to narrowing or stenosis of the venous sinuses, including the transverse sinus. Congenital Anomalies: Some individuals may have an inherent narrowing of the transverse sinus due to structural or developmental abnormalities in the venous system. Fibromuscular Dysplasia: A rare condition that causes abnormal growth in the walls of blood vessels, including veins, which can lead to stenosis in the transverse sinus. DIAGNOSIS Diagnosing transverse sinus stenosis typically involves a combination of clinical examination, imaging, and sometimes diagnostic procedures: Imaging : Magnetic Resonance Imaging (MRI) with Magnetic Resonance Venography (MRV): This is the gold standard for diagnosing transverse sinus stenosis. MRV allows detailed imaging of the venous structures and can identify areas of narrowing or occlusion in the transverse sinus. CT Venography (CTV): This test can also be used to visualize venous sinuses, particularly if MRV is not available or contraindicated. Conventional Venography: This invasive test, which involves injecting contrast into the venous system and taking X-ray images, is rarely used today but may be helpful in certain situations. Lumbar Puncture (Spinal Tap) : A lumbar puncture may be performed to measure opening pressure in the cerebrospinal fluid (CSF). Elevated opening pressure can indicate increased intracranial pressure, which might be secondary to impaired venous drainage from the brain. Fundoscopic Eye Exam: The ophthalmologist may observe papilledema (swelling of the optic disc), which is indicative of increased intracranial pressure and can be seen in patients with transverse sinus stenosis. Ultrasound : In certain cases, Doppler ultrasound of the neck veins may help assess venous flow and detect stenosis or clot formation. TREATMENT The treatment for transverse sinus stenosis depends on the severity of the condition, the underlying cause, and the presence of complications such as increased intracranial pressure or venous thrombosis. Common treatments include: Anticoagulation: If the stenosis is due to venous thrombosis, anticoagulant therapy (e.g., heparin or warfarin) is typically used to prevent further clotting and manage the risk of embolism. Management of Idiopathic Intracranial Hypertension (IIH): If transverse sinus stenosis is associated with IIH (pseudotumor cerebri), treatment may include: Acetazolamide (a carbonic anhydrase inhibitor) to reduce cerebrospinal fluid (CSF) production and lower intracranial pressure. Weight loss for patients who are overweight or obese, as it has been shown to reduce intracranial pressure in IIH. Diuretics like furosemide to reduce fluid buildup. In severe cases, optic nerve sheath fenestration (a surgical procedure to relieve pressure on the optic nerve) or a lumbar peritoneal shunt may be needed. Endovascular Procedures: In cases of severe stenosis or thrombosis, endovascular procedures like angioplasty (dilating the narrowed sinus) or the placement of a stent to keep the vein open may be considered. Surgical Intervention: Surgical interventions may be required to address external compression, such as tumor removal, or to insert a stent in the stenosed transverse sinus STENTING Transverse sinus stenting is a medical procedure used to treat venous sinus stenosis — a narrowing of the transverse sinus. It’s most commonly done in patients with Idiopathic Intracranial Hypertension (IIH)/Pseudotumor cerebri when high pressure in the brain is linked to this narrowing. It’s usually considered when: A person has Idiopathic Intracranial Hypertension (IIH). There is evidence of transverse sinus stenosis on imaging (MRI/MRV, CT venogram). Other treatments (like medication or weight loss) haven’t worked. A pressure gradient (> 4–10 mmHg) is found across the stenosis during venous manometry (a catheter-based pressure test). How the Procedure Works Venous access is typically gained through the femoral vein (in the groin). A catheter is threaded up through the venous system into the transverse sinus. A stent (a mesh-like tube) is placed in the narrowed area to hold it open. This improves blood outflow and can reduce intracranial pressure. PROGNOSIS The prognosis for transverse sinus stenosis depends on the underlying cause and the promptness of treatment. If the condition is diagnosed early and treated effectively, especially in cases of venous thrombosis or IIH, the outcome can be favorable. However, untreated stenosis may lead to chronic increased intracranial pressure, permanent vision loss (due to papilledema), and in severe cases, stroke or cognitive decline. SOURCES https://radiopaedia.org/articles/transverse-sinus-stenosis https://www.sciencedirect.com/science/article/pii/S2772687824001053 https://pubmed.ncbi.nlm.nih.gov/38983575/ https://pmc.ncbi.nlm.nih.gov/articles/PMC11410061/ https://pubmed.ncbi.nlm.nih.gov/21799038/

CRANIOCERVICAL INSTABILITY ATLANTOAXIAL INSTABILITY CCI and AAI are two forms of spinal instability, affecting the skull-C1 vertebrae (CCI) and C1-C2 vertebrae (AAI). They are both structural instabilities that can lead to pathological deformation of the brainstem and upper spinal cord. This page mainly focuses on CCI+AAI caused by lax ligaments failing to keep the craniocervical junction stable. SYMPTOM S Symptoms include Headache Neck pain Altered vision Diplopia Nystagmus Tinnitus Hearing loss Dysautonomia Postural orthostatic tachycardia (high heart rate upon standing) Orthostatic intolerance (Pre) syncope Dizziness Vertigo Urinary tract dysfunction, urgency, frequency GI dysfunction, constipation Weakness Spasticity Clumsiness Altered sensation, numbness (dysesthesia, paresthesias) Abnormal gait Paralysis Sleep apnea Sleep disorders Fatigue Choking, dysphagia Trouble breathing Slurred speech, dysarthria DIAGNOSIS CCI and AAI is diagnosed based on three things - 1) imaging, 2) symptoms and 3) positive neurological findings. A neurosurgeon will look at a patient's imaging and take certain measurements, such as the clivo-axial angle, which if abnormal suggests CCI or AAI. However these measurements cannot stand alone. A neurosurgeon will also go through the patients symptoms, past medical history and do a neurological exam. The symptoms and neurological findings are important to make a final diagnosis while also assessing the severity of the patient's condition. For diagnosing CCI, an upright flexion extension MR(uMRI)I is the gold standard. A digital motion xray(DMX) can be used to further confirm the diagnosis. An ordinary supine brain MRI should also be done to rule out or diagnose comorbidities such as intracranial pressure issues, chiari malformation etc. For diagnosing AAI, a rotational CT scan is considered the gold standard. An upright MRI with rotation can also be used to make a diagnosis. MEASUREMENTS CAUSES There's a number of different conditions that can cause CCI and AAI, some which are widely recognized, while others are still relatively unknown by many medical professionals. The common ones include Autoimmune connective tissue disorders such as rheumatoid arthritis and lupus Genetic conditions such as downs syndrome and osteogenesis imperfecta Conditions causing tumors in the craniocervical junction, such as Neurofibromatosis Other acquired bone conditions such as Paget's disease Severe trauma to the craniocervical junction and head Less commonly known is Hereditary connective tissue disorders, also known as hypermobility syndromes, such as Ehlers-danlos syndrome and the hypermobility spectrum disorders Trauma to the craniocervical junction(CCJ) , that would usually be considered less severe, such as whiplash Grisel syndrome, subluxation of the atlantoaxial joint (C1/2) due to inflammatory ligamentous laxity following an infectious process in the head and neck In these two conditions the instability do not stem from a malformation or degeneration of the bone, but from the ligaments in the CCJ being too lax, to properly stabilize the vertebra. In conditions such as ehlers-danlos syndrome, the laxity comes from a genetic defect of the connective tissue, while in cases of trauma, the laxity stems from the ligaments being stretched during the traumatic incident. MANAGEMENT Unfortunately there's no cure for CCI and AAI, but there is different ways to manage it. The main ones being physical therapy, symptom management, bracing, and as a last resort a spinal fusion surgery can be done. In mild to moderate cases, physical therapy, bracing and treating symptoms can be enough to manage the patient's condition. The physical therapy and symptom management will vary from patient to patient, however isometric neck exercises are one of the most common recommendations. Symptom management might include treating conditions caused or exacerbated by CCI and AAI, such as dysautonomia, medications to manage pain, nausea etc In severe cases this won't be enough to manage the condition, and spinal fusion will be recommended. SURGERY ... Sources https://link.springer.com/article/10.1007/s10143-018-01070-4 https://www.researchgate.net/publication/316895469_Occipito-atlanto-axial_Hypermobility_Clinical_Features_and_Dynamic_Analysis_of_Cranial_Settling_and_Posterior_Gliding_of_Occipital_Condyle_Part_2_Findings_in_Patients_with_Post-traumatic_Condition https://www.researchgate.net/publication/5773233_Syndrome_of_occipitoatlantoaxial_hypermobility_cranial_settling_and_Chiari_malformation_Type_I_in_patients_with_hereditary_disorders_of_connective_tissue https://www.ncbi.nlm.nih.gov/pubmed/28961036

COMMON MISCONCEPTIONS CCI, AAI and spinal instability A Chiropractor, physiotherapist, radiologist or similar can diagnose me with CCI and AAI. - FACT: While a chiropractor, physiotherapist, radiologist or similar practitioner may recognise signs suggestive of CCI/AAI or refer for further investigation, the definitive diagnosis of CCI/AAI — given the need for dynamic imaging, specialist interpretation and management planning — is generally made by a physician (such as a neurosurgeon or neurologist) with expertise in the upper cervical spine. Everyone with CCI and AAI will need fusion eventually - FACT: Many can manage with less invasive treatments , like physical therapy and a cervical collar. A surgical fusion is a last resort in severe cases A fusion will cure CCI and AAI. - FACT: There is no cure for CCI+AAI, and while fusion can be both life saving, and significantly improves quality of life , some symptoms are likely to persist. There's currently no way to properly assess the extent of damage to the brainstem and spinal cord, which makes it hard to predict the outcome of fusion surgery, from a symptom improvement perspective. My MRI/X-ray was read as clear, so i can't have CCI/AAI - FACT: Most medical professionals are not knowledgeable on ligament laxity related instabilities, such as CCI and in some cases AAI. This means they won't order the right imaging or make the right measurements to assess it. Always see a CCI knowledgeable practitioner if you suspect you have it Any neurosurgeon can diagnose CCI/AAI - FACT: Unfortunately CCI/AAI from ligament laxity is still rarely known amongst doctors, even neurosurgeons. The misconceptions about these conditions are widespread, many have not even heard about them. Severity of measurements equal severity of CCI/AAI - FACT: The severity of ones instability is based on a mix of measurements, neurological findings and symptoms. Someone might have severe measurements, but only mild symptoms and no neurological findings and vice versa Intracranial hypertension Everyone with IH has papilledema - FACT: While it is not common, it is possible to have IH without papilledema. It's estimated that between 5-10% of IH patients do not have papilledema. IH headaches get worse when you're lying down, and better when you're upright. - FACT: While a positional headache that comes on when upright is the most common experience , what position triggers pain can vary from person to person. IH is always idiopathic/without a known cause - FACT: There's two types, one being idiopathic, the other being secondary. Recent studies have shown a link between cerebral venous stenosis and intracranial hypertension Tethered cord Tethered cord can always be seen on MRIs - FACT: Tethered cord might be occult , and therefore not be visible on MRIs Tethered cord is something you're born with - FACT: Tethered cord can be caused by an injury or trauma , such as previous surgery to the spine causing scar tissue to form Chiari malformation Only a large herniation causes symptoms - FACT: All sizes of herniations can cause symptoms, as it comes down to compression of the surrounding structures as well as blockage of CSF flow .

RESOURCES GENERAL MEchanical Basis BRAIN FOUNDATION AU CCI MEpedia DR.GILETE - WHAT IS CCI IIH/PC INTRACRANIAL HYPERTENSION RESEARCH FOUNDATION IIH UK CSF LEAK CSF LEAK ASSOCIATION SPINAL CSF LEAK FOUNDATION CHIARI CHIARI BRIDGES CONQUER CHIARI CHIARI AND SYRINGOMYELIA FOUNDATION EDS & HSD THE EDS/HSD TOOLKIT THE EHLERS-DANLOS SOCIETY MIND BODY EDS EHLERS DANLOS UK HYPERMOBILITY SYNDROMES ASSOCIATION

CEREBROSPINAL FLUID LEAK A cerebrospinal fluid (CSF) leak occurs when the cerebrospinal fluid, which cushions and protects the brain and spinal cord, escapes through a hole or tear in the dura mater, the tough outer membrane surrounding the brain and spinal cord. This fluid can leak out through the nose, ears, or spinal area, depending on where the tear is located. A CSF leak can cause the pressure within the spinal canal to drop, leading to an array of symptoms SYMPTOM S - Headaches: Often described as positional headaches, which worsen when standing or sitting up and improve when lying down. Often accompanied by neck stiffness and pain - Clear Fluid Drainage : Clear, watery fluid may drain from the nose (rhinorrhea) or ears (otorrhea). - Nausea and Vomiting : Associated with headaches and intracranial pressure changes. - Hearing disturbances : Hearing loss and ringing in ears (tinnitus) - Visual Disturbances : Blurred vision, double vision and sensitivity to light (photophobia) - Imbalance : Dizziness and a sense of imbalance might occur CAUSES - Trauma : Head or spinal injuries can cause tears in the dura mater. - Surgery : Neurosurgery or spinal surgery can sometimes inadvertently create a tear. - Spontaneous Leaks : These can occur without any obvious cause, often due to weak spots in the dura mater. - Increased Intracranial Pressure : Conditions that increase pressure inside the skull can sometimes lead to CSF leaks. DIAGNOSIS - Clinical Examination : Doctors look for clear fluid drainage and other signs of CSF leak. - Imaging Studies: MRI, CT or Myelogaphy scans can help identify the site of the leak. - CSF Tests: Fluid samples can be tested for beta-2 transferrin, a protein unique to CSF. TREATMENT 1. Conservative Measures: - Bed Rest: Encouraging the patient to lie flat to reduce pressure on the dura and allow it to heal. - Hydration: Increasing fluid intake to maintain CSF pressure. - Caffeine: Sometimes used to help reduce headaches. - Avoid Straining : Patients are advised to avoid activities that increase intracranial pressure, like heavy lifting or straining. 2. Medical Interventions: - Epidural Blood Patch : A procedure where a small amount of the patient’s blood is injected into the epidural space near the leak to form a clot and seal the tear. - Fibrin sealant: A special sealant made from human plasma is injected into the spinal canal to seal the leak. - Surgery: In cases where conservative measures fail, surgical repair may be necessary to close the tear in the dura mater. POTENTIAL COMPLICATIONS Potential Complications: - Meningitis: Infection due to bacteria entering the brain or spinal cord through the tear. - Chronic Headaches : Persistent headaches due to ongoing CSF leakage. - Neurological Symptoms : If the leak affects brain or spinal cord function. PROGNOSIS A CSF leak can significantly impact quality of life, but with proper diagnosis and treatment, many patients recover fully. SOURCES Mayo Clinic – CSF Leak https://www.hopkinsmedicine.org/health/conditions-and-diseases/cerebrospinal-fluid-csf-leak https://www.ncbi.nlm.nih.gov/books/NBK538157/ https://my.clevelandclinic.org/health/diseases/16854-cerebrospinal-fluid-csf-leak

SUSPECTED DIAGNOSIS? CCI & AAI WHERE TO START Knowing where to start when you suspect you, or a loved one, has CCI/AAI can be challenging due to the lack of knowledge of the condition in mainstream medicine. Many have been told by their doctors that nothing is wrong with their neck after a standard MRI or X-ray, although this is rarely enough to make a diagnosis. The first step you should take is finding a practitioner. You can find a list of well established CCI knowledgeable practitioners here . When you have chosen one, reach out to them to ask what imaging they prefer, this varies. Most practitioners offer this imaging as a service, or is able to refer you to a place that does. You can also find our list of upright MRI machines here . Once you have this info, you should consider what sort of consultation you'd like. Some practitioners offer scan reviews, some offer telehealth/remote consultations, and all offer in person consultation. While seeing a doctor in person is always recommended, it's not always accessible due to finances or health limitation. In that situation you might choose to get the relevant scans at the facility closest to you, and get a remote consult or simply a scan review. Keep in mind that most practitioners won't make an official diagnosis or recommendations without an in-person consult, however they can give you an idea of what might be going on, which can be helpful in letting you decide the next step. DIAGNOSED - WHAT'S NEXT Once you're diagnosed or has a suspected diagnosis it's time to decide what management route you want to go. There are both traditional and more alternative options available. You can read a short description of the treatment options here . If your case is severe, especially if there's signs of neurological/brainstem involvement, you might be recommended surgery, while in mild to moderate cases, conservative management is recommended.

GLOSSARY CONDITION

TETHERED CORD SYNDROME Tethered cord syndrome is a neurological disorder caused by a tissue attachment that limits the movement of the spinal cord within the spinal column. This tethering causes the spinal cord to be stretched and damaged as the body grows and moves. SYMPTOM S - Back Pain : Often in the lower back, increasing with activity. - Leg Weakness or Numbness : Affects walking and coordination. - Foot Abnormalities : Such as high arches or curled toes. - Bladder and Bowel Problems : Incontinence or difficulty with urination and bowel movements. - Scoliosis : Abnormal curvature of the spine, which can be associated with tethered cord. - Skin Abnormalities : Such as a fatty lump, dimple, or patch of hair on the lower back. - Muscle contractions : such as clonus CAUSES Congenital (present at birth): - Spina Bifida : A birth defect where the spine and spinal cord don't form properly, often associated with tethered cord. - Lipoma : Fatty tissue that can attach to the spinal cord. - Thickened Filum Terminale : The end part of the spinal cord may be thicker than normal and cause tethering. - Diastematomyelia : A condition where the spinal cord is split into two parts, often causing tethering. Acquired: - Surgery : Scar tissue from previous spinal surgeries can cause tethering. - Injury : Trauma to the spine can result in scar tissue that leads to tethering. DIAGNOSIS - Clinical Examination : Doctors look for physical signs and symptoms. - Imaging Studies : MRI is the most common imaging test used to diagnose tethered cord syndrome, providing detailed images of the spinal cord and surrounding tissues. - Urodynamic Tests : To assess bladder function if urinary symptoms are present. TREATMENT Conservative Management: - Monitoring and physical therapy: for mild cases without severe symptoms. Surgical Intervention: - Detethering Surgery: The primary treatment, which involves surgically releasing the spinal cord from the attached tissue. This aims to restore the normal movement of the spinal cord and prevent further damage. - Postoperative Care : Includes physical therapy and regular follow-up to monitor recovery and ensure that the spinal cord remains free. POTENTIAL COMPLICATIONS - Neurological Damage : If untreated, the ongoing tension can cause permanent damage to the spinal cord. - Re-tethering : In some cases, the spinal cord may tether again after surgery, requiring further intervention. - Infection and Bleeding : Risks associated with any surgical procedure. PROGNOSIS Early diagnosis and treatment are crucial for preventing long-term complications. Many patients experience significant relief of symptoms and improved quality of life after surgery. Regular follow-up is important to monitor for potential recurrence of tethering and manage any ongoing symptoms. OCCULT TETHERED CORD Occult tethered cord syndrome (OTCS) is a condition where the spinal cord is abnormally stretched or anchored, but without the obvious, visible signs seen in classic tethered cord syndrome. The term "occult" means hidden, indicating that the tethering is not easily detected through standard imaging tests or physical examination. OTCS seems to be more prevalent in patients with CCI or ehlers-danlos syndrome, however more research is needed. CAUSES - Congenital Abnormalities : Even though the condition is hidden, it may still be caused by subtle congenital anomalies. - Trauma or Surgery : Scar tissue from previous spinal surgeries or injuries can cause occult tethering. - Degenerative Changes : Age-related changes in the spine that may not be immediately apparent. SYMPTOMS The symptoms of OTCS are similar to those of classic tethered cord syndrome but may be more subtle and harder to diagnose. DIAGNOSIS It is often a clinical diagnosis based on symptoms and physical findings, however in some cases prone lumbar MRI scans are used to identify signs of an occult tether. This is still a fairly new concept and not widely used. SOURCES Tethered Spinal Cord Syndrome – Causes, Diagnosis and Treatments Tethered Spinal Cord Syndrome | National Institute of Neurological Disorders and Stroke Tethered Cord Syndrome - Symptoms, Causes, Treatment | NORD Tethered cord syndrome | Radiology Reference Article | Radiopaedia.org Occult tethered cord syndrome: a rare, treatable condition https://thejns.org/spine/view/journals/j-neurosurg-spine/40/6/article-p758.xml?tab_body=fulltext Full article: Effect of untethering on occult tethered cord syndrome: a systematic review Diseased Filum Terminale as a Cause of Tethered Cord Syndrome in Ehlers-Danlos Syndrome: Histopathology, Biomechanics, Clinical Presentation, and Outcome of Filum Excision - ScienceDirect

SPECIALISTS Below is a list of specialists known to be knowledgeable of cranio cervical instability and related conditions. We do not endorse or recommend anyone. CCI & AAI SPECIALISTS THE US Dr. Fraser Henderson Location: Silver springs, MD Speciality: Neurosurgery Website: https://www.metropolitanneurosurgery.org/dr-fraser-henderson/ Contact info: Phone: (301) 557-9049 or via website Does online evaluations/consults: No Also treats/is knowledgeable on: Chiari malformation, occult tethered cord Other info: Dr. Robert Rosenbaum Location: Silver springs, MD Speciality: Neurosurgery Website: https://www.metropolitanneurosurgery.org/dr-robert-rosenbaum/ Contact info: Phone: (301) 557-9049 or via website Does online evaluations/consults: No Also treats/is knowledgeable on: Other info : Dr. Paolo Bolognese Location: New york Speciality: Neurosurgery Website: http://www.chiarinsc.com/dr.bolognese.php Contact info: Phone (516) 321-2586 and pbolognese@chiarinsc.com Does online evaluations/consults: Yes Also treats/is knowledgeable on: Chiari malformation Other info: Dr. Ibrahim Hussain Location: New york Speciality:Neurosurgery Website: https://neurosurgery.weillcornell.org/faculty/ibrahim-hussain-md Contact info: (888) 922-2257 Does online evaluations/consults: Also treats/is knowledgeable on: CSF leak Other info: Works with Dr. Greenfield Dr . Sunil Patel Location: Charleston, SC Speciality: Neurosurgery Website: https://muschealth.org/MUSCApps/providerdirectory/Patel-Sunil Contact info: Does online evaluations/consults: No Also treats/is knowledgeable on: Other info: Dr . Faheem Sandhu Location: Washington, DC Speciality: Neurosurgery Website: https://www.medstarhealth.org/doctor/dr-faheem-akram-sandhu-md/ Contact info: Does online evaluations/consults: No Also treats/is knowledgeable on: Other info: Dr. Anthony Capocelli Jr Location : Little Rock, AR Speciality: Neurosurgery Website: https://www.orthoarkansas.com/anthony-capocelli-md Contact info: Phone 501-500-3500 or via website Does online evaluations/consults: Also treats/is knowledgeable on: Other info: Dr. Arthur Jenkins Location: New York, NY Speciality: Neurosurgery Website: https://jenkinsneurospine.com/ Contact info: Phone (646) 499-0488 or via website Does online evaluations/consults: Also treats/is knowledgeable on: Other info: Dr. Charles Sansur Location: Maryland Speciality: Neurosurgery Website: https://www.umms.org/find-a-doctor/profiles/dr-charles-a-sansur-md--mhsc-1568679652 Contact info: via website Does online evaluations/consults: Also treats/is knowledgeable on: Other info: Dr. Neill Wright Location: St. Louis, Missouri Speciality: Neurosurgery Website: https://www.neillwrightmd.com/ Contact info: (314) 806-1770 or wright@nwrightmd.com Does online evaluations/consults: Also treats/is knowledgeable on: Other info: Dr. Justin Virojanapa Location: Cincinnati, Ohio Speciality: Neurosurgery Website: https://www.uchealth.com/en/provider-profiles/virojanapa-justin-1598063612 Contact info: (513) 475-8000 Does online evaluations/consults: Also treats/is knowledgeable on: Other info: Dr. Deb A. Bhowmick Location: North carolina Speciality: Neurosurgery Website: https://www.dukehealth.org/find-doctors-physicians/deb-bhowmick-md Contact info: (919) 620-5168 Does online evaluations/consults: Also treats/is knowledgeable on: Other info: Dr. Colin C. Buchanan Location: Colorado Speciality: Neurosurgery Website: https://www.cbsi.md/buchanan Contact info: See website Does online evaluations/consults: Also treats/is knowledgeable on: Chiari Other info: AUSTRALIA Dr. Prashanth Rao Location: Sydney, Australia Speciality: Neurosurgery Website: https://brainandspinesurgery.com.au/ Contact info: Phone: 02 90527567 or info@brainandspinesurgery.com.au Does online evaluations/consults: Unknown Also treats/is knowledgeable on: Other info: EUROPE Dr. Vinc en Ç Gilete Location: Barcelona, Spain Speciality: Neurosurgery Website: https://drgilete.com/ Contact info: +34 93 220 28 09 or info@drgilete.com Does online evaluations/consults : Yes Also treats/is knowledgeable on: Chiari malformation, venous stenosis, (occult) tethered cord, Other info: Dr. Bartolomé Oliver Location: Barcelona, Spain Speciality: Neurosurgery Website: https://chiarisurgery.com/ Contact info: info@chiarisurgery.com or +34 698 991 982 Does online evaluations/consults : Yes Also treats/is knowledgeable on: Chiari malformation, venous stenosis, (occult) tethered cord, intracranial hypertension Other info: ASIA Dr. Atul Goel Location: Mumbai, India Speciality: Neurosurgery Website: https://www.bombayhospital.com/dr-atul-goel.php Contact info: See website Does online evaluations/consults : No Also treats/is knowledgeable on: Other info: Only does C1-C2 fusion Other specialists Dr. Jeffrey Greenfield Location: New york Speciality: Pediatric neurosurgery Website: https://weillcornellbrainandspine.org/faculty/jeffrey-p-greenfield-md-phd Contact info: See website Does online evaluations/consults: No Also treats/is knowledgeable on: Chiari malformation Other info: Works with Dr. Hussain Dr. Petra Klinge Location: Rhode island Speciality: Neurosurgery Website: https://brownneurosurgery.com/our-team/petra-klinge-md-phd/ Contact info: (401) 793-9166 Does online evaluations/consults: No Also treats/is knowledgeable on: Chiari malformation, (occult) Tethered cord Other info: