The Chiari Institute

The Chiari Institute is a specialist medical institution in Great Neck, New York, dedicated primarily to the evaluation and treatment of Arnold–Chiari malformation, syringomyelia, and associated neurological conditions. It was established in 2001 by the North Shore-LIJ Health System after Thomas H. Milhorat, MD, became chairman of neurosurgery within the system. Milhorat and Paolo Bolognese, MD, were the institute's principal founding figures and helped define its clinical and research focus. The institute functions as a treatment facility for patients with Chiari malformations and related illnesses. Its work has included clinical assessment, neurosurgical treatment, and investigation of conditions that may overlap with or complicate Chiari syndromes. Research activities have been associated with the Boas-Marks Research Center on the campus of North Shore University Hospital. Publications connected with the institute have addressed the diagnosis, surgical management, and broader clinical presentation of Chiari-related disorders. Among the research topics reported in connection with the institute was the possibility that syringomyelia can progress rapidly with acute symptoms. A 2003 case report discussed immediate ventriculoperitoneal shunting in such circumstances. Institute-affiliated physicians also reported on decompression surgery supported by color Doppler sonography, a technique intended to help monitor patient-specific anatomical and physiological variables during surgery. The technique had been used by Bolognese before the publication of the report. Another reported line of research concerned the relationship between type I Chiari malformation and hereditary connective-tissue disorders, including Ehlers–Danlos syndrome. The 2007 findings described an overlap between these conditions and suggested that connective-tissue abnormalities could contribute to cervical hypermobility and cranial settling in some patients. Later work associated with institute physicians examined syncope as a possible symptom of Eagle syndrome. The institute has also been the subject of medical-malpractice litigation and public controversy. In 2009, Jennifer Ronca was anesthetized and prepared for a planned brain operation that did not proceed. According to media accounts and subsequent litigation, the scheduled surgeon, Paolo Bolognese, was not present, while Thomas Milhorat declined to perform the operation in his place. Ronca was reportedly given an inaccurate explanation for the postponement. Both physicians were suspended by North Shore University Hospital; Bolognese was later reinstated, while Milhorat resigned. Other lawsuits, including a reported class action, alleged misdiagnosis, the use of procedures for tethered spinal cord syndrome in patients seeking treatment for Chiari malformations, inadequate informed consent, and a lack of identifiable institutional or federal research approvals. The available reference material states that these claims had not been resolved and that no trial dates were known. Paolo Bolognese left the institute on September 1, 2014. The referenced account identifies Raj Narayan, MD, as the institute's leader thereafter. Publicly available source material supplied for this dossier does not establish the institute's current operating status, ownership structure, or present-day service footprint.

The Chiari Institute was established in 2001 by the North Shore-LIJ Health System in Great Neck, New York. Its creation followed Thomas H. Milhorat, MD's appointment as chairman of neurosurgery within the health system. Milhorat and Paolo Bolognese, MD, became the institute's principal founders and developed a specialist program centered on Arnold–Chiari malformation and syringomyelia. The institute combined patient care with medical research. Clinical activity focused on patients with Chiari malformations and related neurological illnesses, while research was conducted in association with the Boas-Marks Research Center at North Shore University Hospital. Work connected with the institute examined both surgical techniques and the wider range of disorders that can accompany or resemble Chiari syndromes. A 2003 case report associated with the institute discussed the possibility that syringomyelia may produce rapidly progressive acute symptoms and argued that immediate ventriculoperitoneal shunting could be required in selected cases. Institute-affiliated physicians also reported on decompression surgery using color Doppler sonography. The method was intended to assist intraoperative assessment of patient-specific variables and had been used by Bolognese before the related publication. In 2007, researchers associated with the institute reported an overlap between type I Chiari malformation and hereditary connective-tissue disorders, including Ehlers–Danlos syndrome. Their findings linked these conditions with issues such as cervical hypermobility and cranial settling. Later research connected with institute physicians examined whether syncope could occur as a symptom of Eagle syndrome. The institution faced significant public and legal scrutiny after a 2009 incident involving patient Jennifer Ronca. She was reportedly anesthetized and prepared for a planned brain operation that was not performed. Accounts stated that Bolognese, the scheduled surgeon, was in Florida and that Milhorat, who had previously operated on Ronca, declined to substitute for him. Ronca was reportedly told that Bolognese had a family emergency, although later accounts characterized that explanation as inaccurate. North Shore University Hospital suspended both doctors. Bolognese was subsequently reinstated, while Milhorat resigned. Additional lawsuits, including a reported class action, alleged that patients had been misdiagnosed and offered tethered-cord procedures for symptoms associated with Chiari malformations. The allegations also raised questions about informed consent and whether the procedures constituted research lacking required institutional or federal approvals. The supplied reference material does not report final resolutions or trial dates for these cases. Bolognese left The Chiari Institute on September 1, 2014. Raj Narayan, MD, is identified in the referenced account as the institute's leader afterward. The supplied sources do not establish whether the institute remains active today, nor do they provide a current website, ownership record, or complete account of its later institutional history.

• 2014

  Bolognese leaves the institute

  [1]The Chiari Instituteen.wikipedia.org

  Paolo Bolognese departed The Chiari Institute on September 1, 2014.

• 2009

  Hospital suspension following postponed surgery

  [1]The Chiari Instituteen.wikipedia.org

  North Shore University Hospital suspended Paolo Bolognese and Thomas Milhorat after the incident involving Jennifer Ronca's planned but unperformed surgery.

• 2007

  Connective-tissue disorder association reported

  [1]The Chiari Instituteen.wikipedia.org

  Researchers associated with the institute reported an association between type I Chiari malformation and hereditary connective-tissue disorders, including Ehlers–Danlos syndrome.

• 2003

  Research on rapidly progressive syringomyelia

  [1]The Chiari Instituteen.wikipedia.org

  An institute-associated case report described acute progression of syringomyelia and discussed immediate ventriculoperitoneal shunting in such cases.

• 2001

  Institute established

  [1]The Chiari Instituteen.wikipedia.org

  North Shore-LIJ Health System established The Chiari Institute in Great Neck, New York, with Thomas H. Milhorat and Paolo Bolognese as principal founding figures.

A focused neurological treatment and research institution specializing in Chiari malformations, syringomyelia, and related disorders rather than a mass-market healthcare brand.

• Specialist medical care · 2001

  Chiari malformation evaluation and treatment

  The institute's central clinical offering was specialist evaluation and treatment for Arnold–Chiari malformation. This included assessment of neurological symptoms and consideration of surgical or other medical management for patients with Chiari-related disorders. The supplied sources do not provide a current service catalog or detailed treatment protocols.

• Specialist medical care · 2001

  Syringomyelia-related care

  The Chiari Institute treated and studied syringomyelia, a condition frequently considered alongside Chiari malformation. Institute-associated publications addressed the possibility of rapid symptom progression and the use of ventriculoperitoneal shunting in selected acute cases.

• Medical research · 2001

  Chiari and neurological research

  Research linked to the institute covered decompression surgery, color Doppler sonography, connective-tissue disorders, Ehlers–Danlos syndrome, cranial settling, and possible neurological manifestations of Eagle syndrome. The work was associated with the Boas-Marks Research Center at North Shore University Hospital.

• 2009

  Jennifer Ronca surgery controversy

  Jennifer Ronca was reportedly anesthetized and prepared for a planned brain operation that did not occur. Accounts said that the scheduled surgeon was absent, a substitute surgeon declined to operate, and Ronca received an inaccurate explanation for the postponement. The incident led to suspensions of both physicians and subsequent litigation.

  Source

• Lawsuits concerning diagnosis, consent, and research approvals

  Reported lawsuits alleged that patients were purposefully misdiagnosed and offered tethered-cord procedures for symptoms attributed to Chiari malformations. The claims further alleged that informed consent was not properly obtained and that required NIH or institutional review approvals could not be identified. The supplied reference states that the suits remained unresolved.

  Source

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• 2014

  Departure of Paolo BologneseOther

  Background

  Paolo Bolognese had been one of the institute's founding physicians and principal contributors.

  Action taken

  Bolognese left The Chiari Institute on September 1, 2014.

  Aftermath

  The referenced account identifies Raj Narayan as the institute's subsequent leader.

  Source

• 2001

  Creation of a dedicated Chiari specialty instituteStrategy

  Background

  North Shore-LIJ Health System created a specialist institution focused on Chiari malformations, syringomyelia, and related neurological conditions.

  Action taken

  The health system established The Chiari Institute in Great Neck and appointed founding specialists Thomas H. Milhorat and Paolo Bolognese to develop its clinical and research program.

  Aftermath

  The institute became associated with specialist treatment and publications concerning Chiari-related disorders.

  Source

1. 1The Chiari Instituteen.wikipedia.org