Over a decade ago, Dr. Dominic Marino and Dr. Curtis Dewey set out to investigate an emerging problem in dogs-called the “Chiari-like Malformation” (CLM). Long-time friends and colleagues, Drs. Marino and Dewey (both board-certified veterinary surgeons) worked together to develop a procedure for the surgical treatment of CLM in dogs, described as “Foramen Magnum Decompression” (FMD).
Despite an approximately 80% success rate with this surgical technique, they subsequently learned that there was a 25% to 50% relapse rate, primarily due to excessive scar tissue formation at the decompression site. Drs. Marino and Dewey seeking advice from leading experts in human Chiari surgery, contacted the coordinator of the Chiari Institute, Ms. Dorothy Poppe and through her learned of a procedure called cranioplasty, in which a titanium plate, constructed using titanium mesh and bone cement is fixed to the back of the skull following a standard FMD procedure.
The cranioplasty procedure had been effective in humans in drastically reducing the incidence of scar tissue impingement of the FMD site. The two surgeons adapted this technique to dogs and published their preliminary results. Four years and more than 150 patients after this paper was published, the postoperative relapse rate associated with the titanium cranioplasty procedure fell to less than 7%.
In addition to addressing the surgical aspects of this devastating disorder, the clinicians at Long Island Veterinary Specialists (LIVS) have been making steady advances in the diagnosis and medical management of dogs with CLM as well as other abnormalities of the craniocervical junction. Dr. Catherine Loughin, senior clinician at the CCI, worked with Dr. Dominic Marino to pioneer the use of medical infrared imaging or “thermography” in screening patients for many conditions including cancer, disc disease, chiari-like malformation, and syringomyelia. Some of these advances include providing whole spine MR imaging to evaluate extent of syrinx formation in CLM dogs, developing a thermal camera-based screening test for the disorder and a method of measuring the actual syrinx volume from MR images. The team at LIVS is also currently evaluating the efficacy of a new drug for managing pain and scratching activity associated with this disorder in an effort to improve the quality of life of their patients. Results of these studies have been presented at human and veterinary conferences both nationally and internationally.