Redefining Treatment for Chiari Malformation with a Transitional Care Model

On this episode of Advances in Care, Erin Welsh and Dr. Jeffrey Greenfield, pediatric neurosurgeon at NewYork-Presbyterian and director of the Chiari CARE program at Weill Cornell Medicine, discuss a rare condition called Chiari malformation.  Typically diagnosed by MRI, Chiari malformation is classified when part of the cerebellum descends into the upper spinal canal. Though some of the most severe types of Chiari malformation can be diagnosed during pregnancy, the most common type may present asymptomatically until adolescence or adulthood, with symptoms that are often misdiagnosed as other disorders. To address the unmet need for proper diagnosis and management of this condition, Dr. Greenfield created the Chiari CARE program–a multidisciplinary approach involving neurology, pain management, neuropsychology, radiology, and more–to help provide full-spectrum care to patients. A key factor of the Chiari CARE program is its emphasis on transitional care, which includes both treating patients who come in as pediatrics throughout their adulthood as well as those who are diagnosed later in life.  But Dr. Greenfield’s vision extends to the future. Having just treated the program’s thousandth surgical patient, his team is amassing and analyzing outcomes data and using machine learning to refine predictions for which future patients would be good candidates for surgery or require other treatment methods that will enhance overall quality of life.  Chapters: [00:00 - 4:12] Chiari CARE Dr. Greenfield and Erin discuss a rare congenital brain condition called Chiari malformation, and highlight Dr. Greenfield’s Chiari CARE program at NewYork-Presbyterian and Weill Cornell Medicine.   [4:12 - 8:35] The Importance of Transitional Care  Dr. Greenfield expands on the importance of transitional care for patients with congenital neurological conditions like Chiari malformation.  [8:35 - 11:51] Determining the Right Approach  Dr. Greenfield explains how he and his team determine whether their patients need surgery or not, and the challenges of diagnosing and treating Chiari malformation in adults.  [11:51 - 14:31] Harnessing Data to Advance Research Dr. Greenfield describes how his team is utilizing the MRI scans from over a thousand patients to develop models that could predict who may be a good candidate for surgery or other treatment avenues.  [14:31 - 18:35] Advancing Diagnostics  Dr. Greenfield shares his vision for an improved coordinated care model for patients newly diagnosed with Chiari malformation.  [18:35 - 19:20] Credits  *** Jeffrey Greenfield, MD, PhD is a board-certified neurosurgeon who specializes in pediatric neurosurgery. In addition he sees certain adult patients with congenital neurosurgical conditions. Compassionate clinical care, research, and education are all central to his philosophy as a neurosurgeon and physician. His clinical expertise includes Chiari malformation, all forms of tethered spinal cord, pediatric brain tumors and congenital neurosurgery into adulthood.  As creator and director of the Chiari CARE program, Dr. Greenfield has developed an international reputation caring for children and adults with Chiari malformation, tethered cord, syringomyelia, and other associated conditions such as craniocervical instability, CSF leaks, and hydrocephalus as part of a large multidisciplinary team. For more information visit  nyp.org/Advances