Whether you are already scheduled to undergo surgery for Chiari malformation or are still in the treatment planning stage, a general understanding of all the available surgical treatment options can help you better understand why your doctor has recommended a particular procedure in your individual case.
The following will address some common concerns Chiari malformation patients have and serve as a quick guide to provide details of each available surgery for Chiari malformation. By having a more thorough understanding of your procedure and what you can expect, you will likely find that you are more comfortable with your upcoming treatment and better able to focus on the healing process.
General Overview of Chiari Malformation
Having a basic idea of how a Chiari malformation develops and affects your body is a good way to begin to understand why surgery is necessary. Before birth, your brain and skull develop together in such a way that they fit together intimately, with just enough room for the delicate brain within the skull.
If the skull does not grow large enough, the brain does not have adequate space and must go somewhere. Because it is easily deformable, the posterior-most area of the brain, the cerebellum, gets pushed out through a hole in the base of the skull called the foramen magnum. This is a Chiari malformation.
The area that extends beyond the bone are called the cerebellar tonsils. Sometimes, they block the foramen magnum, which can prevent the cerebrospinal fluid (CSF) from flowing through as it should. It can also impinge on the spinal cord, causing damage and symptoms.
The goal of any surgery for Chiari malformation is to restore the flow of CSF and/or remove any impingement on the spinal cord by creating more space. This can be accomplished using different methods, including traditional surgical approaches and minimally invasive techniques. Each varies slightly, and the following information will help you understand how.
What to Know: Traditional Dural Opening Chiari Decompression
Traditional dural opening Chiari decompression creates more space for the cerebellum and alleviates pressure within the skull. During this procedure, the surgeon removes a section of skull, opens the dura, the protective membrane that covers the brain, and expands the membrane with a flexible patch to provide more room. The incision site is then closed and allowed to heal.
Need-to-Know Facts:
- This procedure takes place in a hospital setting under general anesthesia. You can expect to spend up to a week recovering in the hospital before returning home.
- Most patients recover at home for six to 12 weeks with activity restrictions and can return to work after that point.
What to Know: Cervical Laminectomy
The goal of a cervical laminectomy is to make more space for the spinal cord rather than the brain. The surgeon removes a small section of your uppermost vertebrae, increasing the size of the spinal canal. This helps remove pressure on the spinal cord, which provides symptom relief and prevents further damage from occurring. This is almost always done in conjunction with traditional or minimally invasive Chiari decompression
Need-to-Know Facts:
- This procedure also takes place within a hospital while you are asleep.
- Most patients are able to get up and walk around within just a few hours of the procedure.
- You will be on activity restrictions for a number of weeks, including anything that requires you to turn your head, such as driving. You may also need to wear a neck brace during the healing process.
What to Know: Minimally Invasive Chiari Decompression
Minimally invasive Chiari decompression is similar to traditional dural opening Chiari decompression but utilizes specialized instruments and microscopic visualization to reduce the size of the incision and disturb less of the surrounding tissues. This technique also eliminates the need for a dural patch.
Need-to-Know Facts:
- This procedure takes place in a hospital while you are under general anesthesia. However, the hospital stay is generally shorter than with traditional surgery for Chiari malformation.
- Because of its minimally invasive nature, patients can expect less pain, less bleeding and a shorter recovery time as compared to traditional dural opening Chiari decompression.
- Most patients who are candidates for other types of surgery for Chiari malformation also qualify for minimally invasive techniques. If your doctor has not discussed using a minimally invasive approach, you may wish to bring it up at your next appointment.
What to Know: Posterior Fossa Decompression
Posterior fossa decompression is another minimally invasive technique used to create more space for the brain. The surgeon creates a small incision at the base of the neck, then uses a special instrument to remove a portion of the occipital bone that encloses the posterior fossa, creating room for the membrane surrouding the brain to expand.
Need-to-Know Facts:
- As with all other types of surgery for Chiari malformation, this procedure takes place in a hospital while you are asleep.
- You can expect a slightly shorter hospital stay of 2-4 days.
- This procedure is often performed in conjunction with a cervical laminectomy, which may increase your recovery time and hospital stay.
Your Individual Treatment Path
Because every patient is different, your doctor has developed a plan based on your individual condition, needs and personal health factors. If you find you still have questions about why your doctor has made the recommendations he has, be sure to bring them up at your next appointment. It’s paramount that you are comfortable with your upcoming treatment, and your doctor will do his or her best to ensure you have confidence in your upcoming procedure so you can focus on recovery.
