Whether you are still in the treatment planning phase or already have your Chiari malformation surgery scheduled, knowing more about your condition and possible surgical treatment can help set your mind at ease. Having a better understanding of your Chiari malformation long-term prognosis can give you an idea of what to expect following surgery, reducing some of the stress of undergoing a medical procedure.
About Chiari Malformation
To better understand the treatment options available, it can be helpful to have a clear idea of what your Chiari malformation is and how it developed. Most people who have Chiari malformation are born with it, which means they are developmental in nature.
As your body grows, your brain and skull develop at the same time in such a way that there is just enough room for the brain to fit inside. However, sometimes the skull does not grow enough, and a portion of the brain, the cerebellum, does not have enough room. When this happens, a portion of the cerebellum is forced out through a hole in the base of the skull called the foramen magnum, which is where the spinal cord leaves the brain.
The reason your doctor has recommended Chiari malformation surgery is that the cerebellar tonsils (the portion of the brain extending out of the foramen magnum) are causing an issue. It may be that they are blocking the flow of cerebrospinal fluid (CSF), that they are impinging on the spinal cord and/or brainstem, or a combination of both.
Chiari Malformation Surgical Treatments
Broadly speaking, there are two different surgical approaches used to treat Chiari malformations: traditional surgery and minimally invasive surgery. The goal of both is to create more space, which restores the flow of CSF, reducing pressure and preventing any further damage as well as providing relief from symptoms. However, each method varies in technique and recovery.
Traditional surgical procedures include dural-opening Chiari decompression and cervical laminectomy. In a decompression procedure, the surgeon removes a section of skull, opens the dura, the membrane covering the brain, and expands it with a flexible patch. This is often done in conjunction with a cervical laminectomy, where the surgeon removes a small portion of your uppermost vertebra.
Minimally invasive treatment of Chiari malformations uses special instruments and microscopic visualization to minimize disruption of surrounding tissues. As a result, most patients experience less pain and a shorter recovery time as compared to traditional procedures.
Minimally invasive Chiari decompression is similar to the traditional approach but uses a smaller incision, may not require opening the dura and does not require the use of a patch.
What to Expect Following Surgery
Your personal recovery will depend on a number of factors, such as which procedure you undergo and your individual health condition. It can be helpful to have an understanding of what most patients typically experience during the recovery process, though your doctor can give you more specific guidelines as to what to expect.
The Months Following Surgery
During the first few months after surgery, your doctor will likely advise you to restrict strenuous activities such as heavy lifting. Your restrictions will be greatest when you first arrive home from the hospital and will be gradually lifted as your body heals. Most patients can expect to return to work and resume pre-surgery activity levels in 6-12 weeks.
You will likely also notice an improvement in symptoms during this period. Many patients experience some degree of relief immediately following surgery, with continuing improvements as time progresses. If your doctor has recommended physical therapy, you will likely begin during this period of time.
The Years Following Surgery
It is also important that you maintain a healthy lifestyle following your Chiari malformation surgery. Your doctor may give you guidelines to follow even into the years after your procedure. Remember that these are for your health and comfort, so it is important that you continue to follow them until your doctor advises otherwise.
Your Recovery Will Be Personal
Now that you have a clearer understanding of your Chiari malformation long-term prognosis, you may find that you have new questions about what you can expect in your individual situation. Take them forward to your next appointment with your doctor to discuss your personal recovery outlook.
Remember that all patients are different, so do not be frustrated if your Chiari malformation long-term prognosis involves a longer recovery time before returning to work or seems different than what you hoped. Your body will take the time that it needs to heal, and your doctor will be there to guide you through the process. Every day will bring you closer to recovery.
