If you or someone you know has a Chiari decompression surgery coming up, you are probably wondering what to expect. Being an informed patient is a great approach, because the more you understand about the procedure, the less overwhelming it may be.
About Chiari Malformation and Why Surgery is Necessary
To understand your upcoming surgery, it helps to know a little bit about your condition and the anatomy of the skull and brain. As you develop, your brain and skull form together in an intimate relationship of grooves and channels within the bone to accommodate the soft tissue of the brain.
For most patients with a Chiari malformation, an area at the back of the skull did not grow as much as it should have, and there is not enough room for a portion of the brain called the cerebellum. As a result, because the brain is softer than bone, it deforms and pushes through an opening at the bottom of the skull called the foramen magnum.
The foramen magnum is the opening through which the spinal cord leaves the skull, and when the cerebellum pushes through, that opening gets blocked. As a result, there is a blockage of the flow of a special liquid that bathes the brain and spinal cord, cerebrospinal fluid (CSF) as well as direct compression on the brainstem and spinal cord. This leads to the symptoms that likely resulted in your diagnosis and scheduled surgery.
The goal of Chiari decompression surgery is to reestablish normal CSF flow patterns and relieve the pressure on the brainstem and spinal cord. This can be accomplished through different techniques, and what your surgeon recommends will depend upon your circumstances and health history.
Chiari Decompression Surgery
There are two types of Chiari malformation treatments, traditional and minimally invasive.
Traditional Approach Overview
A traditional surgical approach is a decompressive suboccipital craniectomy, which may be combined with a cervical laminectomy and patch graft. This involves removing a small section of the back of the skull as well as part of your uppermost vertebrae to create more space and sewing a graft to expand the membranous sac that surrounds the brain. The result is increased space for the cerebellum as well as the spinal cord, allowing CSF to flow more freely.
If your surgeon chooses this approach, you will be placed under general anesthesia. The surgeon will make an incision at the base of the skull, then remove a section of bone. He or she will open a section of the dura, the membrane that covers the brain, and replace it with a patch to allow for more room. If your surgeon has chosen to do a cervical laminectomy, it will also be done at this point. A cervical laminectomy includes removing part of the vertebral bones to create more space and relieve pressure from the spinal cord. Then the soft tissue will be repaired and suture the incision site.
In rare cases, the surgeon will need to repair other bony abnormalities from the front of the skull, which he or she will access either through the mouth or nasal passage. However, as the need for this approach is rare, your surgeon will discuss this further with you if it applies to your condition.
Minimally Invasive Approach Overview
Because of recent technological advances and research efforts, there is an innovative new method of Chiari decompression surgery that may be available to you. Though the goal of creating space and alleviating pressure remains the same, the surgeon uses specialized instruments and microscopic visualization, allowing for much smaller incisions, faster surgery and less disruption of both soft and bony tissue.
This treatment is referred to as minimally invasive because there is a smaller incision site, no graft required and typically a shorter recovery time. Most people who are candidates for traditional surgery are also eligible for this minimally invasive approach, though your surgeon will recommend what he or she feels is best.
Before and After Your Procedure
Food and Liquid Intake (Before)
Because you will be under general anesthesia, your surgeon will give you specific instructions about food and liquid intake before and after your procedure. These orders are for your comfort and safety, and it is important you follow them exactly.
Alterations to Medications (Before)
You may also be taking some medications that need to be modified (dose and frequency) before and after your surgery. Never make changes to your medications yourself. Instead, consult with your prescribing physician and surgeon to find out what changes, if any, need to be made.
Prescribed Pain Medications (After)
Following your procedure, you can expect to spend a few days in the hospital recovering. This allows your healthcare team to maximize your comfort, monitor your recovery, and prevent complications. You will likely be prescribed pain medication to minimize pain. If your surgeon uses a minimally invasive approach, you will probably experience less discomfort and spend less time in the hospital, though this will vary by patient.
Following your discharge, you can expect to have some degree of restrictions, such as:
- Limiting strenuous activity
- Avoiding driving due to medications
- Avoiding certain head and neck movements
Your surgeon will give you a more detailed outlook based on your individual circumstances, but you can expect at least some modifications for at least six weeks.
You may see some symptom relief immediately as the pressure is relieved and CSF flow is restored. However, Chiari decompression surgery is done to prevent further damage, and it is possible that some results may not be seen for up to a year. Your surgeon will discuss your recovery outlook and what to expect, but be sure to raise any further questions or concerns you may have before your procedure.