Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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MRI of brain and spine is the test of choice to evaluate Chiari 1, providing detailed information about brainstem, cervical spine bones, and brain itself including conditions like hydrocephalus. — Francesco Mangano, Pediatric Chiari malformation: presentation and indications for treatment · 12:50
Dr. Francesco Mangano's candidacy statement for ACOS Board of Governors
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This is a statement from Neurological Surgery Board of Governor candidate Francesco T. Mangano, D.O., FACOS, FACS, FAAP.
video2:18 · Nov 2026
Pediatric Chiari malformation: presentation and indications for treatment
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There is a LOT of information to learn as a newly diagnosed patient or caregiver of a patient with Chiari malformation. It can feel overwhelming for a
video38:54 · Nov 2026
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Dr. Francesco Mangano's candidacy statement for ACOS Board of Governors
Dr. Francesco Mangano is the current division chief and professor of neurosurgery and pediatrics at Cincinnati Children's Hospital Medical Center.
clinicalFrancesco Mangano0:02 ↗
Dr. Mangano is the current representative to the neurosurgery section on the Board of Governors.
clinicalFrancesco Mangano0:13 ↗
Dr. Mangano has done volunteer work for the college for the last 20 years in a number of different committees, including the Board of Governors.
opinionFrancesco Mangano0:31 ↗
Engagement of ACOS membership is important for the organization's survival.
opinionFrancesco Mangano0:42 ↗
Primary goals for the next term include membership retention, increasing resident membership, and strengthening the ACOS conference to make it the most important meeting for all ACOS members.
opinionFrancesco Mangano1:01 ↗
Dr. Mangano has the opportunity and time to travel and attend all meetings, to be engaged and present, and to lead and follow leadership within Board of Governors initiatives.
opinionFrancesco Mangano1:27 ↗
There will be engagement with other medical societies that will collaborate with ACOS.
opinionFrancesco Mangano1:49 ↗
Pediatric Chiari malformation: presentation and indications for treatment
Dr. Francesco Mangano is the Mary Jane and Bob Tritsch Chair and Professor of Neurological Surgery and Pediatrics at Cincinnati Children's Hospital Medical Center, joining in July 2005 after neurosurgical residency at Long Island Jewish Medical Center (2004) and pediatric neurosurgery fellowship at St. Louis Children's Hospital.
Host summaryThe host summarizes what Dr. Francesco Mangano said — not the host's own clinical position0:30 ↗
The first described case of Chiari malformation occurred in 1883 with Dr. Cleland, followed by Dr. Chiari reporting on hindbrain herniations and identifying three types, and later Dr. Arnold describing a Chiari 2 case, leading to the term Arnold Chiari malformation.
clinicalFrancesco Mangano2:43 ↗
Chiari 1 through 4 definitions do not represent a continuous spectrum of malformations despite sharing the same name.
clinicalFrancesco Mangano3:13 ↗
Chiari 2 malformations are associated with open neural tube defects and involve caudal displacement of cerebellar vermis, fourth ventricle, and lower brainstem into the foramen magnum.
clinicalFrancesco Mangano3:28 ↗
Chiari 1 malformation is an imaging diagnosis defined as downward displacement of cerebellar tonsils usually to a level of about 5 millimeters below the foramen magnum.
clinicalFrancesco Mangano4:38 ↗
Chiari 1 is generally thought to be congenital, but there is no specific gene; it is probably multigenetic and multifactorial, with familial association reported between 3 and 21% in the literature.
clinicalFrancesco Mangano4:52 ↗
Chiari 1 can be associated with spinal and skull base abnormalities in up to 50% of cases, and has associations with hydrocephalus and tethered cord.
epidemiologicalFrancesco Mangano5:20 ↗
Chiari 0 malformation is described as tonsillar herniation of less than 3 millimeters with a symptomatic syrinx that improves after decompression.
clinicalFrancesco Mangano6:00 ↗
Chiari 1.5 is defined by increased crowding at the foramen magnum with displacement of the brainstem and obex below the foramen magnum level; these patients are more likely to fail and have persistent syrinx after decompression.
clinicalFrancesco Mangano6:31 ↗
The imaging incidence of Chiari 1 in the pediatric population is roughly 3.6%, with approximately 70% of identified patients not symptomatic at presentation.
epidemiologicalFrancesco Mangano7:04 ↗
Syringomyelia occurs in roughly 20 to 75% of Chiari 1 patients on initial imaging, with the majority having cervical spine syrinx and approximately one in five having holocord syrinx at presentation.
epidemiologicalFrancesco Mangano7:21 ↗
Tonsillar displacement prevalence is higher in younger children and decreases as patients reach younger adulthood.
epidemiologicalFrancesco Mangano7:42 ↗
A 2023 review of 700 asymptomatic children without syrinx found roughly 5-6% developed symptoms over time during observation, and about 2-3% developed a syrinx over time.
epidemiologicalFrancesco Mangano7:52 ↗
Published cases of 100 symptomatic patients show improvement over time with observation, with only about 7% worsened with observation only.
epidemiologicalFrancesco Mangano8:18 ↗
There is enough data in the medical literature to warrant watchful observation for patients with non-symptomatic Chiari 1 presenting as children, with natural history more favorable than previously acknowledged.
guidelineFrancesco Mangano8:33 ↗
Most commonly Chiari 1 is an incidental finding; symptomatic patients generally present with headaches and high cervical pain associated with activity or Valsalva maneuvers.
clinicalFrancesco Mangano9:00 ↗
In pediatric populations, typical presentation includes children who must stop playing after short periods due to discomfort, then resume after brief rest.
clinicalFrancesco Mangano9:22 ↗
Other Chiari 1 symptoms include upper motor neuron weakness, incoordination, and brainstem symptoms (swallowing difficulty, central sleep apnea, nystagmus or abnormal eye movements) typically seen more in younger versus older populations.
clinicalFrancesco Mangano9:50 ↗
Syringomyelia is described as enlargement of the central canal, a normal anatomic structure within the spinal cord, generally associated with pain and sensory deficits when symptomatic and can be associated with progressive scoliosis.
clinicalFrancesco Mangano10:20 ↗
General treatment for patients presenting with syringomyelia is surgical decompression at the craniocervical junction, not direct management of the syrinx, though some advocate watchful observation for asymptomatic patients with small syrinx.
guidelineFrancesco Mangano10:39 ↗
MRI of brain and spine is the test of choice to evaluate Chiari 1, providing detailed information about brainstem, cervical spine bones, and brain itself including conditions like hydrocephalus.
guidelineFrancesco Mangano12:50 ↗
Hydrocephalus was identified in Dr. Chiari's first case on postmortem evaluation and is generally reported to be associated with 7-10% of Chiari 1 patients, with literature range between 2 and 18%.
epidemiologicalFrancesco Mangano13:38 ↗
Hydrocephalus has higher association with craniosynostosis and other craniofacial syndromes in Chiari 1 patients.
epidemiologicalFrancesco Mangano14:00 ↗
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