Taking the time to learn about your Chiari malformation and available treatment options is a great way to play an active role in the development of your treatment plan. This can help you feel more comfortable with whatever path you and your doctor determine is right for you, giving you peace of mind and letting you focus your energy on your recovery.
The following information will help you better understand the different minimally invasive Chiari malformation surgery options available. Most patients who are candidates for traditional Chiari malformation surgery are also able to undergo minimally invasive procedures. If your doctor has not discussed these options with you, you may wish to bring it up at your next appointment if you feel it is something you would be interested in.
About Chiari Malformation
As you explore your potential Chiari malformation treatment options, it can be helpful to understand more about your condition and the anatomy involved. Before birth, your brain and skull develop together so there is just enough room for the brain to be encased in protective bone. However, sometimes the skull does not grow large enough to accommodate the brain.
Your Chiari malformation is a result of inadequate growth at the back of the skull, and the area at the back of the brain, the cerebellum, was forced out through a hole at the base of the skull. This hole, the foramen magnum, also contains the spinal cord and blood vessels. The blockage formed by the cerebellar tonsils (the portion of the cerebellum extending outside of the skull) can lead to a backup of cerebrospinal fluid (CSF) and/or direct impingement on the spinal cord, leading to your symptoms.
Minimally Invasive Treatment Options
The goal of any Chiari malformation surgery is to create space in order to alleviate any pressure and impingement that may be present. This can be accomplished through traditional surgical methods or minimally invasive Chiari surgery procedures, which include minimally invasive Chiari decompression and posterior fossa decompression.
Minimally Invasive Chiari Decompression
During minimally invasive Chiari decompression, the surgeon makes a small, one- to two-inch incision at the base of the skull to provide access to the malformation. Once the incision is made, the surgeon uses microscopic visualization and specialized instruments to reach the malformation, disturbing as little of the surrounding soft tissue as possible. The surgeon makes a small opening in the dura, the membrane that covers the brain, which helps relieve the pressure and create more space. This opening can later be closed without the use of a patch. This contrasts with traditional decompression surgery, which requires a much larger incision to allow for removal of a section of skull and typically requires sewing of a patch into the dura, which increases the risk of cerebrospinal fluid leakage.
Posterior Fossa Decompression
Posterior fossa decompression also creates more space for the cerebellum without opening the membrane surrounding the brain. In this procedure, the surgeon still makes a small incision, but instead of opening the dura, he or she uses a specialized cutting bur to shave down a section of the occipital bone of the skull. This increases available space, alleviating pressure and providing relief from symptoms. The doctor will close your incision site, and you will begin your recovery.
What to Expect Following Minimally Invasive Chiari Malformation Surgery
Both forms of minimally invasive Chiari malformation surgery take place in a hospital setting and require a short stay, often just a few days. You will be asleep during the procedure, allowing you to be as comfortable as possible. Immediately following a minimally invasive Chiari malformation surgery, you will recover for a few days within the hospital before you are discharged to recover at home.
During your at-home recovery, you can expect to have some activity restrictions, which will gradually be lifted as your body heals. Most patients return to work and normal activity levels within six weeks. Some patients will also need to undergo physical therapy, depending on individual lingering symptoms. While most patients will experience some form of relief shortly following surgery, other symptoms may take up to a year to resolve fully.
Benefits Over Traditional Chiari Malformation Surgery
Because less of your body’s tissues are affected by minimally invasive Chiari malformation surgery than in traditional approaches, most patients can expect to experience:
- Shorter procedure time
- Shorter hospital stay
- Less postoperative pain, resulting in less need for medication
- Less bleeding
- Shorter recovery time
- Reduced risk of postoperative complications
The Right Treatment for You
By using minimally invasive techniques, surgeons are now able to provide you with Chiari malformation surgery options that can lead to less pain, shorter recovery and reduced surgical risks. This is why many surgeons have come to prefer minimally invasive options and recommend them whenever appropriate.
Again, if you are a candidate for traditional Chiari malformation surgery, chances are you also qualify for a minimally invasive approach. If your doctor has not discussed these as potential treatment options, be sure to bring them up at your next appointment to understand whether or not they could be right for you.
