The Institut Chiari & Siringomielia & Escoliosis de Barcelona (ICSEB) has been working in the area of research since its foundation, following Dr. M. B. Royo-Salvador’s findings and publications on the Filum Disease.

This ongoing work in R&D&I has been officially recognized and validated on a national level since 2011.

We are happy to inform you that also the research carried out in 2023 has been certified with the Research & Development (R&D) accreditation on May 17 2024 by ACIE, the Spanish Innovation Certification Agency.

Congratulations to Dr. Royo-Salvador and the entire R&D&I department for carrying out the research Project “Evaluation of the effectiveness of the Sectioning of the Filum Terminale in patients with idiopathic syringomyelia”!

Rare diseases, despite their name, affect a surprisingly large number of people globally. However, one of the characteristics that makes them “rare” is that their cause is unknown.

In medicine, it is considered that most of rare diseases have a genetic origin, meaning they arise from pregnancy or birth, even if symptoms do not appear until later. Some may also result from combinations of genetic and environmental factors. An early diagnosis is crucial, as a delay can lead to inappropriate treatments or additional complications. However, due to their rarity, they are not studied or understood, and the path to a correct diagnosis and appropriate therapies can be slow and lengthy for many patients and their families.

The Syndrome of Arnold Chiari 0 and I and Idiopathic Syringomyelia, which we focus on and treat in the specialised work of our institute, are no exception to this. They can indeed manifest from birth or later, with symptoms sometimes triggered after trauma. Therefore, the journey towards diagnosis and finding the right treatment is challenging, and often patients experience deterioration during their search.

Thanks to the studies of Dr. Royo Salvador, we now know that the Filum Disease is the common and congenital etiological origin that causes the aforementioned diseases. It dates back to the embryonic development period and can affect various members of the same family.

On this International Rare Disease Day in 2024, we want to emphasise that promoting research and study on Filum Disease and Neuro-cranio-vertebral Syndrome with descent of the cerebellar tonsils and intramedullary cysts allows us to increasingly understand how the mechanism of Filum terminale traction affects the Nervous System in these pathologies. Consequently, early and effective diagnosis and treatments become possible for all patients.

For a better quality of life for the Syndrome of Arnold Chiari I and Idiopathic Syringomyelia patients, support research through a donation to the Chiari & Scoliosis & Syringomyelia Foundation (https://chiarifoundationbcn.com/en/donation-chiari-foundation/), and the future for these patients will become less rare!

Within the field of neurosurgery, an ongoing debate surrounds the diagnosis of Arnold-Chiari Syndrome.

The cerebellar tonsils are an anatomical structure in the lower end of the cerebellum, which have their place in the skull, within the limit of the foramen magnum. When they extend beyond the limit by more than 3-5-7 mm (this value varies depending on the author), and there are no other spinal cord malformations, it is diagnosed as Arnold-Chiari Syndrome type I.

Between 2018 and 2020, some authors introduced a new classification for the types of Arnold-Chiari Syndrome, now including types 0, 1.5, and V.

Within this ongoing discourse, there is a tendency to question whether even a slight descent of the cerebellar tonsils might truly represent a clinical manifestation of Arnold-Chiari, with type 0 being the most contested diagnosis.

In recent literature, some authors report the concept of Arnold-Chiari Syndrome 0 to describe patients who do not have syringomyelia, exhibit minimal tonsillar descent, and display typical Chiari I malformation symptoms and signs such as occipital headaches, posterior cervical pain, and cerebellum-medullary dysfunction. However, there are differing opinions on this classification.

Dr. Royo’s team of specialists confirms that in their case series of patients with Filum Disease, several cases have emerged where the severity of symptoms associated with Chiari malformation does not directly correlate with the extent of tonsillar ectopia. Additionally, they have observed the existence of a clinical presentation similar to Arnold-Chiari I in patients without a clear descent.

In fact, from the perspective of research on Filum Disease as a cause of cerebellar tonsillar descent, the pathologies that can be an expression of Filum Disease in magnetic resonance images include:

“any descent of one or both cerebellar tonsils underneath the foramen magnum plane, represented by McRae’s line… We also define as Impaction of Cerebellar Tonsils their contact or intimate closeness with McRae’s line, that we consider to be an incipient form of Descent of the Cerebellar Tonsils, representing the equivalent of what other authors have denominated ‘Chiari malformation type 0’”

It would undoubtedly be of great significance for patients if a consensus diagnosis is eventually reached and it is recognized that the condition of impacted cerebellar tonsils within the foramen magnum – which can be observed through magnetic resonance imaging, even when it does not exceed 3 mm – may correspond to a clinical presentation that can impact the patient’s quality of life as much as Arnold-Chiari Syndrome I.

Our Institute provides an effective treatment, the Filum System^®, to patients with Arnold-Chiari 0 as well, with excellent results. These results demonstrate that the traction caused by an excessively tense filum terminale can lead to numerous symptoms, even in cases where cerebellar tonsils are only minimally impacted in the foramen magnum. Following our minimally invasive surgical procedure, these symptoms can improve or disappear, thereby restoring a good quality of life for patients.

References:

• Arnold-Chiari Malformation Joaquin A. Hidalgo; Craig A. Tork; Matthew Varacallo. M. StatPearls Publishing; 2023 Jan. 2022 Sep 5.
• Ventrolateral Tonsillar Position Defines Novel Chiari 0.5 Classification; Peter F. Morgenstern, Umberto Tosi; World Neurosurg 2020 Apr;136:444-453. doi: 10.1016/j.wneu.2020.01.147.
• Is there a relationship between the extent of tonsillar ectopia and the severity of the clinical Chiari syndrome?; Heffez DS, Broderick J, Connor M, Mitchell M, Galezowska J, Golchini R, Ghorai J. 2020 Jul;162(7):1531-1538.
• The Filum disease and the Neuro-Cranio-vertebral syndrome: definition, clinical picture and imaging features, BMC Neurology 2020 20:175.

The Filum Disease and the Neuro-Cranio-Vertebral Syndrome can be expressed by various radiological signs, among which is the descent of the cerebellar tonsils below the foramen magnum, also called Arnold-Chiari I Syndrome.

When Dr. M. B. Royo Salvador’s neurosurgical team applies the surgical protocol of the Filum System® method to a patient with Arnold-Chiari I syndrome, the objective of the surgery is to eliminate the cause of the disease, thus stopping its evolution, both in terms of signs and symptoms.

In addition to blocking the descent of the cerebellar tonsils, sectioning the Filum Terminale ligament releases the traction that affects the entire nervous system, thus allowing the recovery of tissues, functions and injuries that are reversible at the time of the surgery.

If, after surgery, the body presents some characteristics of elasticity and organic factors that allow the recovery of the most appropriate anatomical position, it has been proved that in certain cases the cerebellar tonsils tend to ascend towards the foramen magnum.

In our Institute’s caseload, this ascent is observed in some cases 1-2 years after surgery, while in others throughout the first 5-10 postoperative years (Fig. 1).

To our Doctors, the fact that the ascent of the cerebellar tonsils and the clinical improvements experienced by patients are obtained by means of an indirect surgical action performed in a different anatomical area, is a further confirmation that the cause of the disease has been eliminated. The disease is no longer active, nor is the traction force exerted on the spinal cord, brain stem, and spine.

For this reason, after 30 years of excellent results, we can confirm that the Filum System® treatment stops the progression of Arnold-Chiari I syndrome, together with the disappearance or improvement of its subjective symptoms, the satisfactory recovery of objective neurological signs and, in some cases, also the partial or total recovery of the anatomical position of the cerebellar tonsils. The patient’s quality of life improves significantly in the short, medium or long term

Like every year, we join the global recognition of Arnold-Chiari Syndrome, marking this occasion with the hope of a better understanding by the medical community of this condition, and consequently, a better quality of life for patients.

Nearly 50 years ago, Dr. M. B. Royo-Salvador identified the cause behind the descent of the cerebellar tonsils in Arnold-Chiari I: the Filum Disease. From that discovery, he devoted his work to refining an effective surgical solution that targets the condition’s cause and halts progression. This led him to develop a unique, minimally invasive technique: the Sectioning of the Filum Terminale, which is exclusive to the Filum System^® method. This technique was published in 1997, with its results presented in 2005. (https://institutchiaribcn.com/en/dr-royo-publications/).

So far, our Institute has treated over 1,500 cases with descent of the cerebellar tonsils and has achieved outstanding results. We have not only met our goal of halting the disease’s progression but in several instances, we have seen the tonsils rise back to their normal position. We have encountered no major complications in any of the cases. Moreover, 94.6% of patients report a better quality of life in the long run, based on follow-ups conducted 15-20 years post-surgery. This success brings deep satisfaction to our patients, their families, and our dedicated team.

Since starting out, Dr. Royo’s team has diagnosed and confirmed over 2,600 cases of Filum Disease with descent of the cerebellar tonsils. These diagnoses have been made both in-person and remotely, with the team also examining many patients’ family members through relevant tests. Given that the Chiari malformation likely has a genetic origin, we have uncovered more related conditions within families, which might otherwise go unnoticed. We address these findings using a safe and efficient approach.

In conclusion, we are hopeful that our team’s successes, combined with the positive outcomes for our patients and the spread of our method, will empower more specialists to better understand this condition. This, in turn, should guide them in selecting the most suitable treatment for those diagnosed with Arnold-Chiari I.

The team at the Institut Chiari & Siringomielia & Escoliosis de Barcelona is happy to resume its care, administrative and research activity after summer holidays.
If you wish to schedule an appointment for a first consultation or a surgery, our patient care team is at your disposal. We are committed to delivering an excellent service and provide assistance in 15 languages to patients from all around the world.
The R&D department continues its work aimed at broadening and disseminating the findings on the Neuro-cranio-vertebral Syndrome and the Filum Disease.

We are delighted to announce that once again this year, our center, Institut Chiari & Siringomielia & Escoliosis de Barcelona (ICSEB), has received accreditation for our Research and Development (R&D) activities. The accreditation certificate is valid from January 2022.

This achievement follows the publication of an article in BMC Neurology in 2020 titled “The Filum disease and the Neuro-Cranio-vertebral syndrome: definition, clinical picture, and imaging features.”

Currently, ICSEB’s general research project focuses on “Investigation of diseases in spine, brain, connective tissue and their relationship with the filum terminale”.

We would like to extend our congratulations to Dr. Royo and the entire R&D Department at ICSEB for their tireless dedication to researching and studying diseases and pathologies associated with Filum disease and Neuro-cranio-vertebral syndrome. Our Director has been actively involved in this field for 30 years, starting with the publication of his Doctoral Thesis on idiopathic Syringomyelia and its aetiology.

Thank you for your efforts and findings.

We are excited to celebrate the 15^th anniversary of the Institut Chiari & Syringomyelia & Scoliosis de Barcelona (ICSEB). During these 15 years, we have dedicated our efforts to improve the health of individuals suffering from Arnold-Chiari I, idiopathic Syringomyelia and idiopathic Scoliosis and other diseases included in Filum Disease.

Since the foundation of the ICSEB in 2008, we have been pioneers in the diagnosis and treatment of these conditions. We have applied the protocols of the Filum System^® method in more than 3000 first consultations and more than 2100 interventions. Patients from 85 countries on five continents have been able to benefit from the sectioning of the filum terminale by means of a minimally invasive surgical technique, which makes it possible to halt the evolution of the pathology, eliminating its cause – the traction that a congenitally tense filum terminale exerts on the entire nervous system.

Each of the patients we have treated has left a deep impression on us. We have witnessed stories of overcoming, courage and hope. Each step along the way has taught us the importance of empathy, respect and holistic, patient-centred care.

We would especially like to thank our patients and their families for their trust in us. Our mission is to provide them with the best medical care and to support them on their way to a full and healthy life.

In addition, we would like to acknowledge the commitment and dedication of our medical team and our collaborators for making it possible for each patient to receive excellent care; from remote counselling, to diagnosis, treatment and long-term postoperative follow-up. Thanks to their experience, knowledge and vocation, we have achieved great results and have been able to make a difference in the lives of many people.

This anniversary and these results encourage us to look to the future with enthusiasm. We will continue to work at the forefront of medicine, driving research and improving the quality of life of our patients.

We invite everyone to join our celebration, sharing knowledge and raising awareness on filum disease and related conditions.

Thank you all for being part of this 15-year journey!

Osmosis from Elsevier is a health education platform that features interviews with health experts. CEO Shiv Gaglani and Executive Producer Michael Carrese present Raise the Line, a podcast that explores ways to strengthen our healthcare system with leaders in medicine, technology, education and government.

During this year 2023 the podcast is dedicated to raising awareness about rare diseases; for this reason they have invited Dr. Royo Salvador as Director of the Institut Chiari & Siringomielia & Escoliosis de Barcelona and President of the Chiari & Scoliosis & Syringomyelia Foundation, to present the neurological diseases he has been researching for 50 years – idiopathic syringomyelia, idiopathic scoliosis and Arnold-Chiari Syndrome type 1 – and his findings on Filum Disease.

Here you can find the link to the podcast, the presentation of this episode and its transcript: 

Figure.1- A patient’s magnetic resonances and their evolution following the Filum System® treatment, from the first preoperative MRI until the 7-year postoperative check-up, which shows that the medullary cysts disappeared.

Syringomyelia consists of cystic cavities within the spinal cord usually associated with a generalized neurological deterioration. The most frequent symptoms are pain in the extremities, neck pain, alteration of thermal and tactile sensitivity, lower back pain, upper back pain, headache, gait disorders, paresis, sphincter alterations. Living with this condition means dealing with chronic pain and a progressive loss of autonomy.

Our Institute specializes in the diagnosis and treatment of primary or idiopathic Syringomyelia, which, according to Dr M. B. Royo-Salvador’s caudal traction theory, is caused by the Filum Disease. Hence, the syringomyelic cavity is considered to be a consequence of the ischemia produced by the medullary traction that is generated by a tight filum terminale, non-detectable in the neuroimaging.

The treatment we propose to patients at our centre consists in sectioning the Filum Terminale with a minimally invasive technique, according to the exclusive Filum System^® health method. The treatment is applied with the objective of eliminating the root cause of the medullary cavities and stopping the progression of the disease.

After 30 years of interventions since Dr Royo’s discovery of the etiopathogenic mechanism of the disease in 1993, our neurosurgical team continues to see that this condition can be treated with excellent results by applying the Filum System^® health method.

“Actually”, says Dr. M. Fiallos, one of the neurosurgery team’s specialists: “not only is the progression of the syringomyelia stopped, preventing the cysts from capturing medullary tissue and its necrosis from expanding – as our patients’ postoperative MRIs show in the short term – but there are also cases in which MR images show how the cavities collapse and gradually disappear in the medium and long term, not appearing new ones (Fig.1). Sometimes, no traces of the disease are left in the neuroimaging and in parallel we can observe the patient’s clinical improvement.”

Thanks to the treatment that we apply at our centre, the correct blood circulation in the central nervous system is restored: “the results that we have obtained so far are not immediately visible, since they are the indirect consequence of a surgical act. However, they are very satisfactory, both objectively for the neurosurgeons and subjectively for the patients. We perform postoperative check-ups 7-10 years after the intervention approximately and can confirm that the cavities shrink and patients clinically recover”, says the neurosurgeon.

We would like to announce that the Institut Chiari will remain closed on Monday, 1st of May 2023.
You may however send your consultations via email and we will get back to you as soon as possible.
With kind regards, Your ICSEB team.

We would like to inform you that Institut Chiari will remain closed from the afternoon of Thursday 06 of April until Monday 10 of April, due to the Easter holidays.

The Institut will resume its normal activities on Tuesday 11 of April.

Nevertheless, you can email us your questions and we will reply as soon as possible.

Sincerely,

Your ICSEB Team

On the occasion of World Rare Disease Day, 28 February each year, we emphasize that Arnold-Chiari syndrome I and syringomyelia are not uncommon to our experts because of their incidence and number in the population. However, they are “orphan” because they have other typical features of this type of disease.
The Institut Chiari & Siringomielia & Escoliosis de Barcelona (ICSEB) follows the Dr. Miguel B. Royo Salvador’s theory of caudal traction. This theory considers that what causes the cerebellar tonsils to descend Arnold-Chiari Syndrome type I and intramedullary cavities to develop in idiopathic syringomyelia, is a consequence of the abnormal traction of the Filum terminale ligament. This ligament is congenitally tenser than normal, affecting the entire central nervous system.
Our center offers patients the Filum System^® approach, a unique and proprietary method of diagnosing and treating these diseases, which includes minimally invasive surgical intervention to section the filum terminale with excellent results and without complications, stopping the disease development and improving the Quality of Life of patients. It is an alternative to aggressive routine procedures for these diagnoses with frequent and serious complications.
This year, the focus of International Rare Disease Day is on equity, to achieve that everyone has equal opportunities and access to care. Because rare disease patients are more likely to experience inequality, misdiagnosis, and lack of adequate services in their environment.
Our center (ICSEB) has seen patients from 85 countries on 5 continents, each country has a different healthcare system, some of which do not  have a public healthcare system.
Since 1993, ICSEB has operated on more than 2,200 patients using the Filum System^® method with excellent results and a 93% subjective satisfaction rate. Some are reimbursed by their national health systems, others are supported by foundations, including our own – the Chiari & Scoliosis & Syringomyelia Foundation – and most relying on their own funds.
On the website of the Chiari & Scoliosis & Syringomyelia Foundation you can find all the information and the opportunity to get involved in the social help of Filum patients: https://chiarifoundationbcn.com/en/donation-chiari-foundation/
#WorldRareDiseaseDay #RareDiseases

On 16 November Dr. J.M. Arteaga Armas presented a poster of the article “The Filum Disease and the Neuro-Cranio-Vertebral Syndrome: Definition, Clinical Picture and Imaging Features” at the International Conference on Biomedical Engineering and Biotechnology (ICBEB 2022), on behalf of Dr. Royo Salvador, Dr. M.V. Fiallos and the other authors of the article.
We would like to extend our congratulations to both Dr. José Manuel Arteaga Armas, neurosurgeon, researcher and new operational head of the R+D Department of the Institut Chiari & Siringomielia & Escoliosis de Barcelona, for the recognition of the best presentation and the excellent quality of the poster, and Dr. M. B. Royo Salvador, thanks to whom the new concept of Filum Disease continues to be disseminated internationally to improve the quality of life of patients.
Congratulations to our R&D managers!

Many may not be aware that at the Institut Chiari & Siringomielia & Escoliosis de Barcelona (ICSEB), we currently attend to patients from 85 different countries, from five continents, and we provide care in 15 languages.
Our neurosurgical team is formed not only by physicians specialised in neurosurgery, anaesthesiologists, and surgical and assistant nurses, but also by a professional figure that has become central in our work: the patient care contact person. Read a note from a few years ago to learn about the field of expertise covered by the international mediation they deal with: Cultural mediation in the activities at ICSEB.
In Spanish, we call our staff who professionally combine the skills of translators, interpreters, cultural mediators, medical and administrative secretaries, patient spokespersons and liaison, “corresponsal”.
The members of the patient care team have a university degree and native and high-level translation skills in at least four or five languages, are trained internally and externally to collaborate in healthcare, take care of the administrative management of clinical documents, and are trained to mediate in the care relationship between healthcare providers and patients. They all work according to the highest quality standard required by our centre.
Sometimes, before embarking on their trip from abroad to visit and undergo surgery at ICSEB, patients worry about whether they will be provided with translation once they are here. We assure them that this is the case, but we do not explain in detail all the role of the patient care contact person entails.
We believe that most patients will come to understand that role during their experience with our team: it is a professional figure who acts as a bridge between the patient and the physician, their family, and the healthcare professionals, who is aware of everything that has been said and done and who accompanies them during all the services provided here in Barcelona. In addition, they sometimes help with the bureaucratic procedures between the country of origin and Spain.
For the doctor, the “corresponsal” represents the patient, and vice versa, for the patient they represent the doctor. They give them the possibility to understand each other and to do so in a common context which, without cultural mediation and only with translation at the language level, would be insufficient because the health systems and their functioning are different.
Our patient care staff holds the “red thread” of the surgical patient’s relationship with the Institute, from the first contact to the last follow-up, including any medical appointment, report, video-call, preoperative tests, admissions, and procedures.
When a patient is hospitalised, they accompany them to induction, to the operating room, and in the recovery room; they are in direct contact with the ward and with the hospital’s patient care department. They are in charge of each patient’s clinical file, and they also know how to interpret the clinical documentation and the complementary and imaging tests – sufficiently to filter before transmitting it to the doctors – to facilitate their work and optimise their tasks.
In summary, speaking to all those who are hesitant to put themselves in the hands of a medical team far away from home, we wish to convey that, in our case there is no need to worry. We are prepared  to offer everything necessary to welcome you in the best way and to take care of your case thanks to the professionalism and mediation specialisation of our patient care team.

The Institut Chiari & Siringomielia & Escoliosis de Barcelona will remain closed on 26 December 2022 and 6 January 2023.
We would also like to inform that the Institut will be open for the remaining days of the holiday period. The staff at your service will provide all the information you may need regarding your inquiries, possible consultations or surgeries.
Institut Chiari contact numbers: +34 932 066 406 +34 932 800 836

On November 16, Dr. J.M. Arteaga-Armas, neurosurgeon and researcher at the R&D Department of the Institut Chiari & Siringomielia & Escoliosis de Barcelona, presented a poster of the article “The Filum Disease and the Neuro-Cranio-Vertebral Syndrome: Definition, Clinical Picture and Imaging Features” at the International Conference on Biomedical Engineering and Biotechnology (ICBEB 2022), representing Dr. Royo-Salvador and his team.  

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The Institut Chiari & Siringomielia & Escoliosis de Barcelona (ICSEB) joins the International Day dedicated to the Arnold-Chiari Syndrome – a condition our centre is highly specialized in.

We want to remind those who do not know what it means for patients to suffer from Arnold-Chiari syndrome type I, which by definition is characterised by a descent of the cerebellar tonsils below the occipital foramen of the inferoposterior part of the skull, without other malformations in spinal cord.

Such descent of the lower part of the cerebellum below the foramen magnum, according to the almost 50 years of Dr. Royo-Salvador’s research, has its cause in the Filum Disease. Filum disease arises due the congenital traction of the entire nervous system by the ligament Filum terminale, which is tighter than normal.

Suffering from Arnold-Chiari syndrome Type I can lead to a combination of symptoms that progressively increase in frequency and intensity, such as: headache, neck pain, weakness in the extremities, impaired vision, pain in the extremities, paraesthesia, altered sensitivity, dizziness, issues with swallowing, lower back pain, memory impairment, altered gait, back pain, balance disturbance, dysaesthesia, language disorder, sphincter disturbances, insomnia, vomiting, loss of consciousness, and tremors.

The quality of life of a patient with this condition can decrease significantly before finding the possibility of treatment, and not only because the clinical picture is degenerative. Also, because the surgical solutions that are conventionally offered have a fairly high risk being major surgeries such as craniectomy with suboccipital decompression. For this reason, it is usual to wait until the disease is more advanced before applying this type of invasive treatment, so that the risk of surgery does not exceed that of the pathology.

On the other hand, thanks to the findings of Dr. M. B. Royo-Salvador, who has found a method of diagnosis and treatment called the Filum System^®, a greater precision of the affectation of the disease and the elimination of the cause is achieved, with its subsequent evolution being halted; through the minimally invasive surgical procedure of the sectioning of the Filum terminale.

The Filum System^® results for Arnold-Chiari Syndrome type I applied at the ICSEB are very positive: the improvement of some symptoms, the disappearance of others and, above all, an improvement in the patient’s quality of life in general -if only because it does not continue to worsen, like before.

Sometimes, one or more years after the procedure, on the follow-up magnetic resonance imaging of some patients, the ascend of the cerebellar tonsils can be observed; but in general, the important thing is to eliminate the tension caused by the ligament Filum terminale.

On this day dedicated to patients affected by Filum Disease with a descent of the cerebellar tonsils, we want to remember all of them and emphasise that there is new hope where there was none before: the possibility of a treatment that can have many benefits with very little risk.

Past December 2020, the Governing Board of the Col.legi de Metges de Barcelona (Official Medical Board of Barcelona)  agreed to name Dr. Miguel B. Royo-Salvador, director of the Institut Chiari & Siringomielia & Escoliosis de Barcelona; honorary member in recognition of services rendered to the profession and to the board institution.

HOLA Magazine. 11/08/2022

Please note that the Institut Chiari & Siringomielia & Escoliosis de Barcelona’s office hours will be from 09:00 to 15:00 o’clock from 1 August through 5 August 2022. The ICSEB will remain closed from 8 to 21 August 2022.
You can leave a voice message on our answering machine or send us an email and we will contact you promptly when we return. We will get back regarding queries about remote check-ups after the break.
The Institut Chiari will reinitiate its activity on 22 August.
Our telephone numbers: +34 932 066 406 +34 932 800 836

We would like to announce that the Institut Chiari will remain closed on Friday, 24th of June 2022.
You may however send your consultations via email and we will get back to you as soon as possible.
With kind regards, Your ICSEB team.

The Research & Development Department at ICSEB was officially created in 2014, following Dr. Royo-Salvador’s tireless work and the Institute’s on-going clinical activity.
In the first years of his academic studies, in collaboration with Professor José María Domenech (Chair of Anatomy and Embryology, Faculty of Medicine, Universidad Autónoma de Barcelona – UAB – from 1975 to 1992), Dr. Royo-Salvador published his doctoral thesis focussed on understanding idiopathic syringomyelia and its etiologic mechanism.
Since then, he devoted himself to understanding what he later discovered was the cause of an excessive caudal traction exerted on the entire nervous system by the Filum Terminale ligament. He described its pathological functioning – until then of unknown origin – within all the related conditions (Arnold-Chiari I Syndrome, idiopathic Siringomielia, idiopathic Scoliosis, Basilar Impression, Platybasia, Odontoid retroflexion, Kinking of the brainstem and others). Hence, he went on to describe a new disease, the Filum Disease, which includes the above-mentioned conditions.
In patients with these diagnoses, Dr. Royo-Salvador started applying a minimally invasive treatment, the Sectioning of the Filum Terminale. The description, implementation and perfection of the surgical technique generated an extensive casuistry, several lines of research and a series of publications dedicated to deepen each new pathognomonic concept related to the Filum Disease and its treatment.
In the meantime, at ICSEB they were developing a set of highly specialized protocols for the Filum Disease, which have been registered as Filum System^® health method. These protocols revolve around the etiopathogenesis, the diagnosis, and the medical, surgical and rehabilitation treatment.
In 2020 the ICSEB research team published an article in which they describe the clinical and imaging diagnosis of the Filum Disease, based on a sample of 373 cases. Thus, the Filum Disease and the Neuro-cranio-vertebral syndrome were further reaffirmed as entirely different from other syndromes, with which they were often confused, especially with the Occult tethered cord syndrome.
Currently, our R&D Department, in collaboration with Universidad de Barcelona (UB), Universidad Autónoma de Barcelona (UAB) and Sanitas CIMA Hospital, continues to study all possible areas of interest, conditions that are included and associated with the Filum Disease, technical, methodological, neurosurgical and expert systems advances. Their sole objective is contributing to knowledge and to new findings, to provide patients with a better quality of life.
Most of the research projects, as well as the free trainings on the research findings and the financial aid to support patients’ treatment, are funded by the Chiari & Scoliosis & Syringomyelia Foundation (CSSF). The CSSf’s main and almost only benefactor is Dr. Royo-Salvador. Any additional contribution to the cause will be much appreciated. If you wish to make a donation, please go to: https://chiarifoundationbcn.com/donar/
Research & Development Department at Institut Chiari & Siringomielia & Escoliosis de Barcelona

We were honoured to receive Dr. Antoni Capdevila Cirera’s visit this past 10^th of May. Dr Capdevila Cirera is an important figure for our project. He contributed, in his day, 342 cases from the Centre Mèdic de Ressonància Magnètica de Barcelona – Spain’s first Magnetic Resonance centre in 1986 –  to the elaboration of Dr Royo-Salvador’s doctoral thesis “Contribution to the etiology of Syringomyelia” (1992).

Our visitor was gifted a copy of the book Filum System^® Bibliography from ICSEB’s side.

The Institut Chiari & Siringomielia y Escoliosis de Barcelona establishes Casa ICSEB to accommodate not only our care activity for patients from all around the world, but also the work of our R&D department.

People stop us on the street, they congratulate us. Neighbours ask about the construction site on Paseo de Manuel Girona and Calle Dr. Ferrán. Some recognise us because we are from the area; others do not even know who we are. However, everyone is happy with the change happening at the Manuel Girona 32 address. This informative note is for them and everyone who is curious to learn a little more about the building and those who will be occupying it.

Casa ICSEB

The emblematic Noucentista building from the 1920s is located in the Pedralbes neighbourhood, in the current Les Corts district, on the southwest corner of the intersection of Paseo Manuel Girona and Dr. Ferrán Street. Classified as an asset of urban interest, it is part of the historical heritage of the Catalan capital.
Antonio Miracle y Mercader obtained the construction permit from the then Constitutional City Council of San Vicente de Sarriá on 24 April 1915, as Managing Director of the “Promotion of Property” public limited company. For a few years, the two semi-detached houses were in a sad state of abandonment and deterioration, even seeing squatters in different parts of the building.
The new project began in July 2018, after passing through the Department of Heritage and Architecture, History and Art of the Barcelona City Council, the processing of building permits from the Barcelona City Council, Barcelona Parks and Gardens, the Municipal Institute, the report to the Architects’ Association of Catalonia (COAC), the mandatory report of the Prevention, Fire Extinction and Rescue Services (SPEIS), and others.
The Manuel Girona 32 houses, once extended and rehabilitated under the design and guidance of architect Jorge Dávalos Errando, have now become the new Casa ICSEB (short for Institut Chiari & Siringomielia & Escoliosis de Barcelona). ICSEB is a medical and research centre concerned with different neuro-cranio-vertebral conditions, which has the support of professors from the Faculty of Medicine of the Autonomous University of Barcelona, the Institut Neuròlogic de Barcelona and the Chiari & Scoliosis & Syringomyelia Foundation.
As of November 2021, a very promising phase begins: the move to the new offices, to accommodate not only our growing care work for patients from all over the world, but also the work of our R&D department, which studies a pathology that affects all humans and mammals: the Filum Disease.
ICSEB’s NEW ADDRESS Paseo Manuel Girona 32, 08034 Barcelona
We are looking forward to welcoming you at the new Casa ICSEB!
We are committed to continue offering and researching the best solutions for our patients.

The purpose of the online meetings is to address the challenges that AISACSISCO members, residents in France and Italy and ICSEB patients, are currently experiencing. The attendees will be able to ask the Institute’s professionals general questions related to medical, administrative, bureaucratic, economical and logistic topics.
The following professionals will participate in the online sessions and clear doubts about general medical, neurosurgical, and psychological issues:
Dr. Miguel B. Royo-Salvador, Neurosurgeon and Neurologist, Director of ICSEB, President of CSSf;
Gioia Luè, General Health Psychologist at CSSf and coordinator of surgical Patient Care at ICSEB;
Translators: Samantha Meir, French Department, Patient Care Elena Vitturi, Italian Department, Patient Care
– Webinar attendance will be free.
– Webinars are aimed at patients and families, representatives and members of the AISACSISCO Association.
The attendees will be able to send their queries in advance to the ICSEB team; should any other topics arise during the sessions, these will be addressed as well (please note that medical queries regarding personal cases will not be answered during the webinars).
– Registration: please contact the President of AISACSISCO, Mrs. Marisa Toscano, [email protected], Tel: +390921380360 and Mrs. Maria Teresa Ierano: [email protected]
– Webinar agenda: 22/4/22  12:00-13:30 First webinar in French 29/4/22  12:00-13:30 First webinar in Italian (A) 06/5/22  12:00-13:30 First webinar in Italian (B)
All those who registered to the webinars will receive a link to join each session.

We would like to inform you that Institut Chiari will remain closed from the afternoon of Thursday 14 of April until Monday 18 of April, due to the Easter holidays.
The Institut will resume its normal activities on Tuesday 19 of April.
Nevertheless, you can email us your questions and we will reply as soon as possible.
Sincerely, ICSEB Team

The Institut Chiari & Siringomielia & Escoliosis de Barcelona will remain closed on 31 December 2021 and 6 January 2022.
We would also like to inform that the Institut will be open for the remaining days of the holiday period. The staff at your service will provide all the information you may need regarding your inquiries, possible consultations or surgeries.
Institut Chiari contact numbers: +34 902 350 320 +34 932 066 406 +34 932 800 836

The “Institut Chiari & Siringomielia & Escoliosis de Barcelona” will be closed on December 6th and 8th, 2021, due to national holiday.

The “Institut Chiari & Siringomielia & Escoliosis de Barcelona” will be closed on November 1, 2019, due to national holiday.

The specialists at the Institut Chiari & Siringomielia & Escoliosis de Barcelona request to examine the brain and spinal cord magnetic resonances (MRIs) – especially the cranium-cervical, thoracic and lumbar-sacral-coccygeal spine MRIs – in order to confirm the diagnosis of Filum Disease. In addition, a Scoliogram (X-ray of the entire spine on one film, profile and front view, taken in standing position) is requested to study the bony part.
These neuroimaging diagnostic tests allow to detect the characteristic anatomical expressions of the Filum Disease: the descent of the cerebellar tonsils, the syringomyelic cysts, images of ischemia-oedema in the spinal cord, abnormal curves of the spine, malformations of the occipital hinge, multiple disc disease and any other image suggesting an excessive and abnormal traction produced by an overly tense Filum Terminale.
Thanks to the above mentioned neuroimaging tests, many patients have been diagnosed of Filum Disease through other associated conditions, such as Arnold-Chiari Syndrome Type 0 and I, Idiopathic Syringomyelia and Idiopathic Scoliosis, Platybasia, Basilar Invagination, Kinking of the brainstem and Odontoid Retroflexion.

The Filum Disease and the lumbar MRI in prone position

Some specialists use a lumbar Magnetic Resonance Imaging (MRI) in prone position for the diagnosis of the Occult Tethered Cord Syndrome.
As for the diagnosis of the Filum Disease, there is no study that demonstrates this MRI is useful. The diagnosis of the Filum Disease is performed exclusively according to the Filum System^® method, which is the result of the research carried out at the Institut Chiari & Siringomielia & Escoliosis de Barcelona and whose mark guarantees the application of all its protocols to protect patients from imitations.

The “Institut Chiari & Siringomielia & Escoliosis de Barcelona” will be closed on October 12, 2021, due to national holiday.

The Institut Chiari & Siringomielia & Escoliosis de Barcelona will remain closed on September 24th due to a local holiday.

You may however send your consultations via email and we will get back to you as soon as possible.

With kind regards,

Your ICSEB team.

The Institut Chiari & Siringomielia & Escoliosis de Barcelona will remain closed from 9 to 22 August 2021.

You can leave a voice message on our answering machine of send us an email and we will contact you promptly when we return.

We will get back regarding queries about remote check ups after the break.

Institut Chiari telephone numbers:

+34 932 066 406

+34 932 800 836

Dr. M. B. Royo Salvador started applying the minimally invasive Sectioning of the Filum Terminale in 1993. Until today, his neurosurgical team operated and carried out the follow-up according to the Filum System® method of over 1850 patients diagnosed of Filum Disease and Neuro-cranio-vertebral Syndrome, with Arnold-Chiari Syndrome type I, Idiopathic Syringomyelia, Idiopathic Scoliosis and other malformations and related conditions.

In the preoperative phase of our patients’ surgical programme, our specialists always emphasize the fact that the surgery eliminates the root cause of the disease and stops its progression or worsening. The intervention does not act directly on the consequences of the condition – i.e. the lesions of the nervous system, the symptoms and associated dysfunctions.

In most patients, from the immediate postoperative period, the improvement or disappearance of some symptoms can be appreciated, while others alleviate over time, in the following months or years. The same occurs in cases with postoperative rehabilitation and physical therapy: many patients present a functional progressive improvement as well, also from the first postoperative months.

On the other hand, there is a minority of patients who, in the first postoperative stage, do not observe any improvement in their clinical picture or in their autonomy, although they are maintaining a stable and not worsening condition. We wish to address ourselves especially to these patients, to prevent them from feeling discouraged and forgotten when comparing themselves with other patients who experienced a favourable outcome in the short or medium term.

First of all, each clinical picture is different and despite the possibility of presenting similar symptoms, they cannot be compared to those of another patient. Only the specialist will be able to assess the evolution of every single patient, through clinical and imaging check-ups.

Secondly, there are two types of lesions that determine symptoms: reversible and irreversible ones. Although, through the application of the treatment, the traction force that the Filum Terminale exerts on the entire nervous system is released, helping recovery also in the medium and long term, the nervous system will not be able to regenerate irreversible lesions, and recovery will be more limited.

Likewise, our specialists observe that initially some patients can experience improvements and, in some cases, even the disappearance of symptoms. However, later on, due to traumas, accidents, stress, medication, menstrual cycle alterations, physical efforts, there can be a relapse, with the recurrence of the clinical picture prior to surgery. When this happens, it usually takes some time before the patient can return to the postoperative stability. In general, once the associated condition is resolved, the patient improves again.

Finally, in some cases, apart from the Filum Disease for which surgery is performed, there can be one or more additional diagnosis with its own clinical picture, which can share some symptoms with the Filum Disease.

Obviously, after the Filum Disease surgery and throughout the postoperative evolution phases, it could be difficult to determine which symptoms depend on one condition and which ones on the other; or whether some symptoms do not improve because they are related to another diagnosis, or they worsen because it is necessary to treat the other condition. In these cases, our Doctors recommend consulting the corresponding specialist to specifically address and treat also the other active and comorbid cause.

To conclude, Dr. Royo’s team, thanks to their highly specialised expertise, confirm that the release of an overly tense Filum Terminale is the most effective way to help improve patients’ health conditions, even when the recovery may seem slower and more gradual, or other complicating factors intervene.

The Sectioning of the Filum Terminale according to the Filum System® method in general unequivocally improves the patients’ quality of life, with a significant remission of symptoms and a very satisfactory recovery in most cases. Furthermore, the treatment provides a good prognosis to patients whose health condition is severely compromised by the disease, despite not acting directly on the consequences of the Filum Disease.

We are delighted to share the good news with you: thanks to the good evolution of the pandemic, the increase in the vaccinated population -including ICSEB staff-, the decrease in travel restrictions by the Spanish government, and the decrease in the rates of infection and mortality; from now on, our Institute will again receive patients without the need of carrying out a PCR-test or any analytical test related with Covid-19 to access the medical visits on our premises.

We will continue to apply all the necessary precautions to ensure your protection: the use of masks, hand hygiene, and interpersonal distance.

We hope that with the new possibilities of international travel and the progressive reduction of the restrictions previously imposed due to healthcare measures, many patients who were waiting for this moment will finally be able to travel to our center so that our team of specialists can help them as soon as possible.

You can now book your medical appointments!

We would like to announce that the Institut Chiari will remain closed on Monday, 24th of June 2019.
You may however send your consultations via email and we will get back to you as soon as possible.
With kind regards, Your ICSEB team.

We would like to announce that the Institut Chiari will remain closed on Monday, 24th of May 2021.
You may however send your consultations via email and we will get back to you as soon as possible.
With kind regards,
Your ICSEB team.

In the current circumstances marked by the COVID-19 pandemic, many doubts may arise. Patients and family members are wondering, for example, whether people with Filum Disease can be considered a risk group for COVID-19.

At the Institut Chiari & Siringomielia & Escoliosis de Barcelona we would like to provide the most relevant and pertinent information that we have, to try and answer – and possibly solve – these doubts.

COVID-19 is a new condition with a very variable behaviour, making it difficult to identify the factors or circumstances responsible for its mortality or harmlessness.

Researchers and medical professionals are studying in COVID-19 all that is related to both the SARS CoV2 virus and the human host, that make this union so lethal for some patients.

One of the first scientific articles on the severity of COVID-19 is by Zsuzsanna Varga (Zurich, Switzerland) in The Lancet¹ April 17 2020, which states the existence of an inflammation of the innermost layer of cells of the blood vessels – the endothelium – of various vital organs, such as the heart, brain and kidneys. There are currently 1680 articles COVID-19 endothelitis in general and 822 articles on COVID-19 brain endothelitis.

FIG 1. Diffuse ischemic lesions of the deep white matter. MRI visible diffusion (based on live detection of water molecule movement) in a patient with COVID-19, shows numerous focal ischemic lesions in the hemispheric deep white matter (A, white arrow), the corpus callosum (A, red arrow), basal ganglia, middle cerebellar peduncles and cerebellar hemispheres (B, white arrows) ².

This inflammation, which appears in the brain endothelium of severe COVID-19 cases, (Fig.1), can cause in many patients a sensation of “brain fog”, a neurological alteration that is observed both in severe and mild patients. It is one of the long-term COVID-19 sequelae that more and pore people report having suffered or are still suffering, with significant consequences for their quality of life.

“Brain fog”, which includes difficulty with memory, concentration, speech and naming, confusion, dizziness, fatigue, may be aggravated in some patients with other brain lesions that favour or predispose to it, in the form of further inflammation or cerebrovascular accidents.

Our medical and research team described a new condition, the Filum Disease, in which a diffuse alteration in the cerebral blood circulation was observed, predominantly in the white matter areas (Figure 2) ³.

FIG 2. Diffuse ischemic lesions of the deep white matter. MRI of a patient with Filum Disease showing numerous focal ischemic lesions in the hemispheric deep white matter, the basal ganglia (red arrows), which disappeared after surgery.

We can assume that the predisposition to other brain injuries due to endothelitis can aggravate or increase sequelae in patients with COVID-19 and Filum Disease.

We know that this cerebral inflammatory predisposition of the Filum Disease can be solved with the surgical treatment proposed for it, therefore an early diagnosis with the application of the adequate treatment may be recommended.

There exist an additional problem, due to the fact that the Filum Disease, being a recently described condition, hardly diagnosed and apparently of wide global incidence, in general is unlikely to be taken into consideration in association with COVID-19.

References

1. ZsuzsannaVarga , Andreas J Flammer , Peter Steiger , Martina Haberecker , Rea Andermatt , Annelies S Zinkernagel , Mandeep R Mehra , Reto A Schuepbach , Frank Ruschitzka , Holger Moch. Endothelial cell infection and endotheliitis in COVID-19. Case Reports. Lancet. 2020 May 2;395(10234):1417-1418.
2. R Hanafi, P-A Roger, B Perin, G Kuchcinski, N Deleval, F Dallery, D Michel, L Hacein-Bey, J-P Pruvo, O Outteryck, J-M Constans. COVID-19 Neurologic Complication with CNS Vasculitis-Like Pattern. AJNR Am J Neuroradiol. 2020 Aug;41(8):1384-1387. doi: 10.3174/ajnr.A6651.
3. The Filum disease and the Neuro-Cranio-vertebral syndrome: definition, clinical picture and imaging features. BMC Neurology 2020, May 15. 20:175. https://rdcu.be/b36Pi.

Link: https://vimeo.com/490725199

2020 has been a different year, marked by the current circumstances, and it has been also a very special year for Dr. Miguel B. Royo Salvador.

The founder and director of the Institut Chiari & Siringomielia & Escoliosis de Barcelona (ICSEB) turns 70 and celebrates it together with another great achievement of a long and successful life: the publication of the description of the Filum Disease, a new condition discovered thanks to years of research and incessant work.

All the team at ICSEB would like to pay a small tribute of appreciation and affection to this enthusiastic neurosurgeon, entrepreneur, neurologist, neuroscientist and researcher, whose multifaceted professional and personal path has made him unique.

Congratulations Doctor Royo!!

Homenaje en el 70º cumpleaños del Dr. Miguel B. Royo Salvador from Institut Chiari de Barcelona on Vimeo.

Link: https://vimeo.com/485405612

The “Institut Chiari & Siringomielia & Escoliosis de Barcelona” will be closed on October 12, 2020, due to national holiday.

The Institut Chiari & Siringomielia & Escoliosis de Barcelona will remain closed on September 24th 2020 due to a local holiday.
You may however send your consultations via email and we will get back to you as soon as possible.
With kind regards,
Your ICSEB team.

The Institut Chiari & Siringomielia & Escoliosis de Barcelona will not attend consultations in person from 10 to 21 August. You can leave us a message by email or phone (from 9:00 to 14:00 Monday through Friday). We will resume our activity on Monday 24 of August. Institut Chiari telephone numbers:

At the Institut Chiari & Syringomyelia & Scoliosis de Barcelona we are pleased to announce that starting July 1 we will resume our activity.

The return to our activity will be gradual, following the necessary implementation of the new health measures to guarantee the safety of both patients and professionals.

We also would like to assure all our patients and people who are waiting for a medical consultation or to book their surgical programme at our centre, that we will contact each of them to schedule appointments and treatments, so that they can organize their trip to Barcelona conveniently.

Dr. Miguel B. Royo-Salvador and the Institut Chiari & Siringomielia & Escoliosis de Barcelona are pleased to announce the publication: The Filum disease and the Neuro-Cranio-Vertebral Syndrome: definition, clinical picture and imaging features.

Following the health authorities’ instructions for measures to contain the propagation of the disease COVID19, the Institut Chiari & Siringomielia & Escoliosis de Barcelona will remain closed starting tomorrow, 31 March, until the state of alarm currently in place will have finalized.
We will continue to be present and available for our patients’ queries via email, as well as for first informative requests.

Barcelona, Health Magazine 2.0 Spring Edition

Following the health authorities’ instructions for measures to contain the propagation of the disease COVID19, the Institut Chiari & Siringomielia & Escoliosis de Barcelona will not attend consultations in person during the next three weeks.
You can reach us by phone, email, Skype or mail. We will continue to be at your disposition you and all calls and messages will be responded as soon as possible.
You can reach us on over the phone from 9:00 to 14:00 o’clock from Monday to Thursday.

In order to answer this question, we have to consider the following:

1. The COVID-19 is a new disease that has recently transferred from an animal species to humans. Therefore, we know very little about it, it is only 3 months and 18 days old.
2. We are not aware of any Filum Disease case with COVID-19. Although most likely there are tens of thousands.
3. We know that patients with COVID-19 present fever, headache, dry cough and, in the most severe cases, respiratory distress which affects the lungs.
4. The COVID-19 behaves similarly to a common flu. In the majority of cases, 80% can go unnoticed or with very few symptoms.

Given the above-mentioned considerations, we suppose that:

1. The COVID-19 can increase the headache, as the intracranial pressure increases due to the infectious process and coughing, the latter being considered a Valsalva maneuvre. This can worsen the symptomatology of a possible descent of the cerebellar tonsils or Arnold-Chiari Syndrome Type I.
2. Cough in COVID-19 can as well aggravate the symptomatology of a syringomyelic cavity, similarly to cough in common flu, that is to say, generally in a very mild way.
3. Lung involvement in COVID-19 can add to the involvement of the respiratory centre in the brain stem, which can occur in the Filum Disease. This can as well aggravate a restrictive lung syndrome in a severe idiopathic scoliosis. In exceptional cases.
4. With time, we will see whether COVID-19 affects other organs such as the nervous system, the cardiac system or others. This will condition the prognosis of the association Filum Disease and COVID-19. As far as we have observed, there is little or no possible involvement of other organs due to the COVID-19.
5. In general, the Filum Disease does not represent an increased risk for the COVID-19.

On the occasion of the International Women’s Day, we want to highlight the work of all the women who are part of the Institut Chiari & Siringomielia & Escoliosis de Barcelona.

In the context of the Rare Disease Day on 29 February, the Institut Chiari & Siringomielia & Escoliosis de Barcelona (ICSEB) draws attention to the importance of a correct diagnosis and treatment. In fact, erroneous information can lead to taking the wrong decision, with possible serious consequences for the patient’s health.
Therefore the ICSEB, together with the Chiari & Scoliosis & Syringomyelia Foundation and the Filum Academy Barcelona, promotes research, training and dissemination of knowledge about the Filum Disease, which includes conditions that are currently considered to be rare.
Arnold-Chiari Syndrome type I and Idiopathic Syringomyelia are among these conditions and share the same root cause – the anomalous traction that an overly tense Filum Terminale exerts on the spinal cord and the entire nervous system. Today for both conditions there is a minimally invasive treatment that allows avoiding severe complications (or even death).
Spreading information can save lives. This 29 February – and the rest of the year – fight against Rare Diseases!

Barcelona, Revista de la Salud 2.0 winter edition 2019

The Institut Chiari & Siringomielia & Escoliosis de Barcelona will remain closed on 25, 26 December 2019, 1 and 6 January 2020.
We would also like to inform that the Institut will be open for the remaining days of the holiday period. The staff at your service will provide all the information you may need regarding your inquiries, possible consultations or surgeries.
Appointments for consultations will restart on 7 January 2020.
Institut Chiari contact numbers: +34 902 350 320 +34 932 066 406 +34 932 800 836

The “Institut Chiari & Siringomielia & Escoliosis de Barcelona” will be closed on December 6, 2019, due to national holiday.

Barcelona, Health Magazine 2.0 Senior Special Edition 2019

Barcelona, Spetember 2019

Barcelona, Health Magazine 2.0 Autumn Edition 2019

The Institut Chiari & Siringomielia & Escoliosis de Barcelona will remain closed on September 24th 2019 due to a local holiday.
You may however send your consultations via email and we will get back to you as soon as possible.
With kind regards,
Your ICSEB team.

The Institut Chiari & Siringomielia & Escoliosis de Barcelona will remain closed on September 11th 2019 due to a local holiday.
You may however send your consultations via email and we will get back to you as soon as possible.
With kind regards,
Your ICSEB team.

We would like to communicate that at the “Institut Chiari & Siringomielia & Escoliosis de Barcelona” we have resumed our normal activities on 19th of August 2019.
If you require any information on consultations, possible medical visits and surgical procedures, you can send us an email or call us at the following numbers:
+34 902 350 320 +34 932 066 406 +34 932 800 836
The team ICSEB.

We are pleased to inform you that Dr. Miguel Royo-Salvador, director of the Institut Chiari & Siringomielia & Escoliosis de Barcelona, has been awarded with the Dr. Gómez Ulla Award for Health Excellence 2019 bye the Institute for Professional Excellence (Instituto de Excelencia Profesional –IEP) this past 28^th of June 2019, in recognition of his professional prestige and his commitment to excellence.

Press Note

Barcelona, Health Magazine 2.0 Summer Edition 2019

We are pleased to present to all patients, family and friends the new comic about the Filum Disease. From now on, patients and/or relatives have the opportunity to have a good time reading while waiting for their appointment with the doctor.
The purpose of this comic is, through simple drawings, to convey the concept of the Filum Disease and offer to the readers an easy and quick way to get to know it.
We hope you enjoy your lecture! At the Institut, we are constantly thinking of possibilities to make our knowledge widely available and thus be able to help patients affected by Arnold-Chiari I Syndrome, idiopathic Syringomyelia and idiopathic Scoliosis, to fight against their diseases.

Download PDF

We would like to announce that the Institut Chiari will remain closed on Monday, 24th of June 2019.
You may however send your consultations via email and we will get back to you as soon as possible.
With kind regards, Your ICSEB team.

Here at Institut Chiari & Siringomielia & Escoliosis de Barcelona, we are pleased to announce that we already have the new version of Filum System^®: A Brief Guide in Chinese!

We currently have the Filum System^®: A Brief Guide in 8 languages: Spanish, French, Italian, Polish, Russian, English, Portuguese and Chinese.
We hope that our hard work of translation would be very useful and it would help you to know and better understand the diseases associated with the Filum Disease: Neuro-Cranio-Vertebral Syndrome, Arnold-Chiari type I Syndrome, Idiopathic Syringomyelia, Idiopathic Scoliosis, etc.
To obtain your copy of the Brief Guide in your preferred language, you can contact the secretary of the Chiari & Scoliosis & Syringomyelia Foundation:
Nina Arutiounova [email protected] (+34) 93 280 08 36

San Giovanni in Fiore, 31th May 2019

31th May is a special day for me. I could say it is my ninth birthday because nine years ago I was born again. Today, I want to send a special thanks to those who improve people’s lives every day, as it has happened to me. After nine years, I can say that there are exceptional people in the world, such as Dr. Miguel B. Royo Salvador, Miss Gioia Luè, the entire team of the Institut Chiari de Barcelona (Spain) and the members of the association AI.SAC.SISCO Onlus (Italy). They brought me back to life, giving me the strength to be reborn and smile again.
Thank you with all of my heart because if today I can write my story, it is because I owe it all to my adored Dr. Miguel B. Royo Salvador. I will never stop thanking him for what he did for me because, without his help, I would not have been here for years.
Dear Doctor, I will always carry you in my heart and I will always thank you for what you did for me. Thank you for existing!
Maria Pia Ambrosio

We would like to announce that the Institut Chiari will remain closed on Monday, 10th of June 2019.
You may however send your consultations via email and we will get back to you as soon as possible.
With kind regards, Your ICSEB team.

The Institut Chiari & Siringomielia & Escoliosis de Barcelona would like to point out the risks of trusting imprudent health care professionals.

There is a multitude of information circulating in the professional domain as well as in communication channels that, if on the one hand it offers different perspectives, on the other, it can complicate understanding and decision making. Medical and health professionals have a responsibility commitment to the sick, to transfer information as clear and exhaustive as possible, to allow them to make the most appropriate decisions about their own health.
The Institut Chiari & Siringomielia & Escoliosis de Barcelona (ICSEB) promotes education and the dissemination of knowledge, being aware that all this affects the patients’ decisions about her/his health and safety. It is on that account that we have prepared this open letter.
We would like to alert about the possible risks of relying on professionals who do not act with due prudence when offering a surgical treatment that they claim is the same as the one practiced by our team. As a matter of fact, they do not have the necessary knowledge nor the experience to achieve our excellent results.
This warning arises due to a misunderstanding about the treatment offered by our Institute. Some people mistakingly believe that the most transcendent aspect of our work is the type of surgical procedure that we perform. However, what is most paramount is to have discovered a new disease, which affects the entire human nervous system: the Filum Disease.
The research carried out by Dr. M. B. Royo-Salvador, ICSEB’s director, has linked together the Arnold-Chiari Syndrome Type I, idiopathic Syringomyelia and Scoliosis and other diseases in a single concept: the Filum Disease. Dr. Royo-Salvador is one of the most prolific authors on these diseases.
The mentioned diseases share the same cause: an abnormal tension of the filum terminale. The Filum Disease affects the spine, the skull and the central nervous system, causing pain throughout the body, changes in sensitivity to temperature and touch, lack of strength in the extremities, fatigue, dizziness, instability, even including alterations of the memory and concentration, and it has a wide range of symptoms and signs. Its consequences can be irreversible.
It is true that the design of an exclusive health method that includes a minimally invasive surgical technique has been a step that saves lives, as it allows us to eliminate the cause of the disease, as well as mortality and morbidity rates of conventional treatments. But it is essential to clarify that this surgical technique is A PART of the health method, which we have developed and that encompasses a series of protocols, which must be respected rigorously.
To offer our treatment correctly, the medical team to apply it needs to know how to correctly diagnose and know what kind of treatment should be applied. Then, it needs to know how to apply it with the best surgical techniques and know how to accompany each case, in a personalized way, for many years.

As you can see the word TO KNOW is repeated in all stages, and that is not a coincidence. To achieve the development of the treatment we offer today, it has been necessary to know, and a great deal! It took more than 40 years of research, which is still ongoing, since our Institute, in addition to seeing patients from more than 75 countries, is the only one in Europe recognized for its research and development of the diseases that we treat, holding the I + D + i accreditation by the Certification Agency in Spanish Innovation (ACIE).
ICSEB has furthermore gained the recognition of innovation by listed in the Spanish Registry of “Innovative SME” of the Ministry of Economy, Industry and Competitiveness; the new “Certification ISO 9001: 2015 (IQNet and AENOR)”, in the activities of research, diagnosis and treatment of the Filum Disease and also in the diagnosis and treatment of neurosurgical diseases.
One of the results of the constant effort to consolidate the protocols and quality standards is the satisfaction rate among operated patients, which is 94.2%, with excellent subjective clinical and surgical results. Likewise, in February 2019, Dr. Miguel B. Royo-Salvador has been distinguished as a member by the Academy of Health Sciences Ramón y Cajal for his research and prestige at an international level.
Even with this successful journey, our Institute has been contacted very rarely by Health care professionals interested in learning more about our treatments. Through the Filum Academy Barcelona^®, our center has given free medical and health care training courses to professionals interested in the Filum Disease and in the accreditation for the application of the protocols of our method.
Unfortunately, some medical professionals, instead of helping patients to have treatment with us or to consult us to receive adequate training about our discoveries and the treatments we offer, prefer to try to discredit our work. But when they observe the excellent results achieved, they begin to examine our operated patients and then say that they can “do the same” when, in reality, they are completely unaware of it. And that puts at risk the results of the treatments and, of course, the health of the patients.
We have already received numerous cases of patients who have had poor results and complications, because of professionals who tried to do what, in reality, they did not know. The problems observed include wrong diagnoses and treatments and also ineffective interventions and/or with serious errors, which worsened the clinical picture of the patients.
The problem is that it becomes more complex to reoperate after erroneous treatments and procedures. In addition, some people may be mistaken and think that these poor results are due to the type of treatment we practice at our Institute. This discredits our method and, what is worse, it prevents patients from obtaining the excellent results that the knowledge of a great discovery, a good diagnosis and a great treatment, could offer them. All this would harm not only an investigation of over forty-five years; but also hundreds of millions of affected people who could benefit from our method.
Of course we know that no patient has the duty to know how to differentiate our treatment from what other doctors say they do. Therefore, we believe that we have the duty to alert you to the possible consequences of a wrong decision.
Before taking a decision, ask yourself:

• Is the neurosurgeon I am talking to a specialist for my condition? How many years has he/she spent studying it?
• Does he/she have many publications that support his/her knowledge and experience about the subject?
• Can he/she explain to me clearly why he/she proposes an surgery using their own arguments and data?
• On how many patients has he/she performed the procedure?
• Does he/she apply the sectioning of the filum terminale in cases of tethered cord syndrome, when it is generally contraindicated?
• Does he/she offer economic advantages to try and persuade me?
• Does he/she say that he/she trained with Dr. Royo when, in fact, ICSEB has already informed me that this is not true?
• And finally: if you believe that it is such a simple treatment, that any neurosurgeon can do it, why do thousands of patients from all over the world consult and come to the ICSEB?

Beware of health care professionals who claim to do what they do not know; these false promises can have serious consequences for your health.
INSTITUT CHIARI & SIRINGOMIELIA & ESCOLIOSIS DE BARCELONA

The Institut Chiari & Siringomielia & Escoliosis de Barcelona would like to point out the risks of trusting imprudent health care professionals.

There is a multitude of information circulating in the professional domain as well as in communication channels that, if on the one hand it offers different perspectives, on the other, it can complicate understanding and decision making. Medical and health professionals have a responsibility commitment to the sick, to transfer information as clear and exhaustive as possible, to allow them to make the most appropriate decisions about their own health.
The Institut Chiari & Siringomielia & Escoliosis de Barcelona (ICSEB) promotes education and the dissemination of knowledge, being aware that all this affects the patients’ decisions about her/his health and safety. It is on that account that we have prepared this open letter.
We would like to alert about the possible risks of relying on professionals who do not act with due prudence when offering a surgical treatment that they claim is the same as the one practiced by our team. As a matter of fact, they do not have the necessary knowledge nor the experience to achieve our excellent results.
This warning arises due to a misunderstanding about the treatment offered by our Institute. Some people mistakingly believe that the most transcendent aspect of our work is the type of surgical procedure that we perform. However, what is most paramount is to have discovered a new disease, which affects the entire human nervous system: the Filum Disease.
The research carried out by Dr. M. B. Royo-Salvador, ICSEB’s director, has linked together the Arnold-Chiari Syndrome Type I, idiopathic Syringomyelia and Scoliosis and other diseases in a single concept: the Filum Disease. Dr. Royo-Salvador is one of the most prolific authors on these diseases.
The mentioned diseases share the same cause: an abnormal tension of the filum terminale. The Filum Disease affects the spine, the skull and the central nervous system, causing pain throughout the body, changes in sensitivity to temperature and touch, lack of strength in the extremities, fatigue, dizziness, instability, even including alterations of the memory and concentration, and it has a wide range of symptoms and signs. Its consequences can be irreversible.
It is true that the design of an exclusive health method that includes a minimally invasive surgical technique has been a step that saves lives, as it allows us to eliminate the cause of the disease, as well as mortality and morbidity rates of conventional treatments. But it is essential to clarify that this surgical technique is A PART of the health method, which we have developed and that encompasses a series of protocols, which must be respected rigorously.
To offer our treatment correctly, the medical team to apply it needs to know how to correctly diagnose and know what kind of treatment should be applied. Then, it needs to know how to apply it with the best surgical techniques and know how to accompany each case, in a personalized way, for many years.

As you can see the word TO KNOW is repeated in all stages, and that is not a coincidence. To achieve the development of the treatment we offer today, it has been necessary to know, and a great deal! It took more than 40 years of research, which is still ongoing, since our Institute, in addition to seeing patients from more than 75 countries, is the only one in Europe recognized for its research and development of the diseases that we treat, holding the I + D + i accreditation by the Certification Agency in Spanish Innovation (ACIE).
ICSEB has furthermore gained the recognition of innovation by listed in the Spanish Registry of “Innovative SME” of the Ministry of Economy, Industry and Competitiveness; the new “Certification ISO 9001: 2015 (IQNet and AENOR)”, in the activities of research, diagnosis and treatment of the Filum Disease and also in the diagnosis and treatment of neurosurgical diseases.
One of the results of the constant effort to consolidate the protocols and quality standards is the satisfaction rate among operated patients, which is 94.2%, with excellent subjective clinical and surgical results. Likewise, in February 2019, Dr. Miguel B. Royo-Salvador has been distinguished as a member by the Academy of Health Sciences Ramón y Cajal for his research and prestige at an international level.
Even with this successful journey, our Institute has been contacted very rarely by Health care professionals interested in learning more about our treatments. Through the Filum Academy Barcelona^®, our center has given free medical and health care training courses to professionals interested in the Filum Disease and in the accreditation for the application of the protocols of our method.
Unfortunately, some medical professionals, instead of helping patients to have treatment with us or to consult us to receive adequate training about our discoveries and the treatments we offer, prefer to try to discredit our work. But when they observe the excellent results achieved, they begin to examine our operated patients and then say that they can “do the same” when, in reality, they are completely unaware of it. And that puts at risk the results of the treatments and, of course, the health of the patients.
We have already received numerous cases of patients who have had poor results and complications, because of professionals who tried to do what, in reality, they did not know. The problems observed include wrong diagnoses and treatments and also ineffective interventions and/or with serious errors, which worsened the clinical picture of the patients.
The problem is that it becomes more complex to reoperate after erroneous treatments and procedures. In addition, some people may be mistaken and think that these poor results are due to the type of treatment we practice at our Institute. This discredits our method and, what is worse, it prevents patients from obtaining the excellent results that the knowledge of a great discovery, a good diagnosis and a great treatment, could offer them. All this would harm not only an investigation of over forty-five years; but also hundreds of millions of affected people who could benefit from our method.
Of course we know that no patient has the duty to know how to differentiate our treatment from what other doctors say they do. Therefore, we believe that we have the duty to alert you to the possible consequences of a wrong decision.
Before taking a decision, ask yourself:  

• Is the neurosurgeon I am talking to a specialist for my condition? How many years has he/she spent studying it?
• Does he/she have many publications that support his/her knowledge and experience about the subject?
• Can he/she explain to me clearly why he/she proposes an surgery using their own arguments and data?
• On how many patients has he/she performed the procedure?
• Does he/she apply the sectioning of the filum terminale in cases of tethered cord syndrome, when it is generally contraindicated?
• Does he/she offer economic advantages to try and persuade me?
• Does he/she say that he/she trained with Dr. Royo when, in fact, ICSEB has already informed me that this is not true?
• And finally: if you believe that it is such a simple treatment, that any neurosurgeon can do it, why do thousands of patients from all over the world consult and come to the ICSEB?

Beware of health care professionals who claim to do what they do not know; these false promises can have serious consequences for your health..

 INSTITUT CHIARI & SIRINGOMIELIA & ESCOLIOSIS DE BARCELONA

The Institut Chiari & Siringomielia & Escoliosis de Barcelona team wishes you a Happy Sant Jordi’s Day.
On this special day, celebrated in Catalonia by gifting books and roses to your partner and loved ones, we want to extend our invitation to discover the publications edited by Chiari & Scoliosis & Syringomyelia Foundation (CSSf):

You can download the Filum System^® Bibliography sas a pdf file:

We would like to inform you that Institut Chiari will remain closed from the afternoon of Thursday 18 of April until Monday 22 of April, due to the Easter holidays.
The Institut will resume its normal activities on Tuesday 23 of April.
Nevertheless, you can email us your questions and we will reply as soon as possible.
Sincerely, ICSEB Team

Throughout Institut Chiari & Siringomielia & Escoliosis de Barcelona (ICSEB)’s history, several patient have obtained total or partial reimbursements from their respective public or private health care authorities:
 53 Italian patients have obtained partial or total reimbursement of medical expenses, the majority refunded by their country’s public health system, and others have received refunds from private insurance companies. This makes up 60% the ICSEB patients who have obtained reimbursement.
5 Spanish patients have obtained partial reimbursement of the medical expenses arisen at ICSEB, refunded by the Spanish public health service.
There are cases where this has obtained from the corresponding authorities, or through private insurance companies, in the following countries: France, United Kingdom, Portugal, Denmark, Belgium, Kazakhstan, USA, Costa Rica and Japan.
Regarding insurance companies that have reimbursed medical expenses made by their policyholders, they are: AXA, ALLIANZ, CIGNA (from the US) and Tokio Marine Nichido Life Ins. (Japanese)

We have pleasure to announce that Dr. Miguel B. Royo-Salvador, Director of the del Institut Chiari & Siringomielia & Escoliosis de Barcelona, has been honoured as a member of the Distinguished Academy of Science and Health Ramón y Cajal las 23 February 2019 for his research and international standing.

Press release Distinguished Academy
Ramón y Cajal

The theme for Rare Disease Day this year is “bridging health and social care”, with the objective of bridging the gaps of communication and coordination among all services, to improve the patient’s well-being.
Knowledge and information are key for both medical and social professionals, as well as for patients and their families. Understanding the disease and the options that are available to manage it can positively influence the patient’s quality of life.
Since its constitution, the Institut Chiari & Siringomielia & Escoliosis de Barcelona, together with the Chiari & Scoliosis & Syringomyelia Foundation and the Filum Academy Barcelona, promotes research, training and dissemination of knowledge about the new Filum Disease, which has been acquired in over 40 years’ work.
With his doctoral thesis in 1992, Dr. Royo Salvador proved the theory that considers several diseases of unknown cause, such as Arnold-Chiari Syndrome Type I, Idiopathic Syringomyelia, Idiopathic Scoliosis, Platybasia, Basilar invagination, Odontoid retroflexion, Brain stem kinking, as part of a new disease concept (the Filum Disease) and that they share a common cause (spinal cord and entire nervous system traction).
For the diagnosis, treatment and follow-up of the Filum Disease and the related conditions, the Filum System^® health method has been designed. This protocolized system includes among its treatments the sectioning of the Filum Terminale with minimally invasive surgical technique, which halts the progression of the disease and improves its symptoms with almost no risks nor complications.
Arnold-Chiari Syndrome Type I, Idiopathic Syringomyelia, Idiopathic Scoliosis and other conditions considered to be of unknown cause, are manifestations of the Filum Disease and today they have a treatment.
Find out how we can help you: https://institutchiaribcn.com/en/test-filum-disease/

The Institut Chiari & Syringomyelia & Scoliosis de Barcelona and the Chiari & Scoliosis & Syringomyelia Foundation are saddened to announce that Xavier Antón Fernández passed away last January 12, after a long struggle with illness. Xavier Antón was the Manager of the Institute and Patron of the Foundation, a great example of professional and personal commitment. His integrity and coherence with the values he lived by with great simplicity will guide and inspire us to keep up working.
The whole team sends its deepest condolences to his family.

The Institut Chiari & Siringomielia & Escoliosis de Barcelona will remain closed on 25, 26 December 2018 and 1 January 2019.
We would also like to inform that the Institut will be open for the remaining days of the holiday period. The staff at your service will provide all the information you may need regarding your inquiries, possible consultations or surgeries.
Appointments for consultations will restart on 2 January 2019.
Institut Chiari contact numbers: +34 902 350 320 +34 932 066 406 +34 932 800 836

The “Institut Chiari & Siringomielia & Escoliosis de Barcelona” will be closed on December 6, 2018, due to national holiday.

On October 31st, 2018, on the occasion of the 10th-anniversary celebration of the Chiari & Scoliosis & Syringomyelia Foundation (CSSf), the journalist David Morales interviewed Dr Royo Salvador in the radio program Nits de Radio of Onda Cero.
In the interview, Dr Royo spoke about the CSSf’s mission, an entity created to make available Dr Royo’s more than 40 years of medical-scientific research to all the patients.
The foundation has the purpose of spreading the knowledge of the new Filum Disease (FD) and its related pathologies (Arnold-Chiari I Syndrome, Idiopathic Syringomyelia and Idiopathic Scoliosis, among others). Also, CSSf spreads the word about the Filum System^®: a method designed for the diagnosis, treatment and follow-ups of the FD. The Foundation fights for the well-being of patients, so they can get the most appropriate treatment and all the necessary support.

The “Institut Chiari & Siringomielia & Escoliosis de Barcelona” will be closed on November 1, 2018, due to national holiday.

It was an evening of memories, hugs, demonstration of gratitude and lots of emotions. Last Friday 26^th of October 2018, the event for the celebration of 10 years of the Chiari & Scoliosis & Syringomyelia Foundation was held in the Auditorium of the Medical Association of Barcelona. During the event, organized in collaboration with the Institut Chiari & Siringomielia & Escoliosis de Barcelona and the Col·legi Oficial de Metges de Barcelona, the play “Tutta colpa di Arnold” (“All because of Arnold”) was presented for the first time in town. The drama piece was written, directed and interpreted by the artist and patient Rita Capobianco.
Enjoy our photo gallery with the event’s best moments.

The day of the event is approaching! This Friday 26^th of October at 18:30, we’ll celebrate 10 years of the Chiari & Scoliosis & Syringomyelia Foundation. The event, organized in collaboration with the Institut Chiari & Siringomielia & Escoliosis de Barcelona and the Col.legi Oficial de Metges de Barcelona (Medical Association of Barcelona) will be held in the Auditorium of the Medical Association of Barcelona. In this occasion, the play “Tutta colpa di Arnold” (“All because of Arnold”) will be presented for the first time in town. The drama piece is written, directed and interpreted by the artist and patient Rita Capobianco.
For more information on the event, follow this link: https://institutchiaribcn.com/en/chiari-scoliosis-syringomyelia-foundation-cultural-event/

The “Institut Chiari & Siringomielia & Escoliosis de Barcelona” will be closed on October 12, 2018, due to national holiday.

The Institut Chiari & Siringomielia & Escoliosis de Barcelona will remain closed on September 24th 2018 due to a local holiday.
You may however send your consultations via email and we will get back to you as soon as possible.
With kind regards,
Your ICSEB team.