If your physician has recommended that you seek treatment for your Chiari malformation, it may be because your condition is causing increased pressure on your spinal cord and/or brainstem. If that is the case, one treatment option is minimally invasive Chiari decompression, an innovative surgical procedure developed by the surgeons at Neurosurgeons of New Jersey.
In order to understand the procedure, it is helpful to review what a Chiari malformation is and why it can be problematic.
As a person grows, the brain and skull develop together, creating a perfect match between the brain and its protective bone covering. However, in some patients, there is a mismatch between the shape and/or size of the skull and the amount of room that area of the brain at the back of the head, called the cerebellum requires. As a result, the cerebellum does not fit within the space properly. Instead, it is forced out through the hole at the bottom of the skull, where the spinal cord exits. The result can be a buildup of cerebrospinal fluid as well as increased pressure on the brain.
About Minimally Invasive Chiari Decompression
Decompression is a means of relieving the pressure that has built up as a result of your Chiari malformation, and it is a common surgical treatment designed to relieve symptoms related to your condition. Traditional Chiari decompression surgery typically involves removing a section of skull, opening the tissue layers surrounding the brain and spinal cord and sewing in a graft (patch of tissue that can be synthetic, harvested from a separate donor site, or treated animal tissue) creating more room for the cerebellum.
However, our surgeons at Neurosurgeons of New Jersey have developed an innovative, minimally invasive Chiari decompression surgery that accomplishes the same result as a standard Chiari decompression but allows for:
- Smaller incision
- Reduced blood loss
- No need for grafting (avoiding need for separate donor site or implantation of foreign material/tissue of animal origin)
- Watertight closure
- Shorter surgical time
- Reduced risk of postoperative complications (cerebrospinal fluid leak, pseudomeningocele, meningitis, brainstem sag)
- Less postoperative scar formation (which may reduce chance of postsurgical recurrence)
- Less pain medication use post-op
- Quicker post surgical recovery
Most patients who are candidates for standard Chiari decompression surgery also qualify for minimally invasive Chiari decompression. Some patients may also be candidates for a non-dural opening procedure which can also be performed through a minimally invasive approach.
Goal of Minimally Invasive Chiari Decompression
Because the symptoms of Chiari malformation are a result of pressure on the spinal cord and/or brainstem, the goal of both standard and minimally invasive Chiari decompression surgery is to relieve that pressure and reestablish normal cerebrospinal fluid flow. The minimally invasive approach achieves this through a much smaller incision, with the added benefits discussed above.
How Minimally Invasive Chiari Decompression Is Performed
One of the benefits of minimally invasive Chiari decompression surgery is that the surgeon only needs to make a small, 1.5- to 2-inch incision at the back of the head. This results in less pain and less blood loss for the patient, and you will likely experience a quicker recovery and reduced need for postoperative pain medication.
After the surgeon makes the incision, he or she uses specialized designed retractors and surgical tools, to expose the appropriate area of the skull and spine, allowing access to the brainstem and cerebellum through the small opening. Specialized instruments and microscopic visualization tools allow the surgeon to make a small opening in the dura (the connective tissue layer that covers the brain and spinal cord), that can later be closed without the use of a patch graft. This is in direct comparison to standard Chiari decompression surgery, which typically involves significant disruption of muscular connections to the skull and spine, the use of large retractors that stretch and distort the surrounding tissues, and a large opening in the dura that requires patch graft repair
Because of the minimally invasive approach, the smaller surgical corridor, and reduced tissue disruption, the surgery itself takes less time than standard Chiari decompression treatment.
Though recovery time is different for every patient, you can expect to spend a little less time in the hospital after your surgery because of the minimally invasive nature of the procedure. Likewise, because the incision site is smaller than that in standard Chiari decompression surgery, healing of the surgery site will probably be shorter and may be less painful. However, because there is still a risk of leakage from the incision, albeit reduced, your surgeon will provide you with specific postoperative instructions and limitations.
Following your surgery, you will typically need to restrict your activities, limiting things such as driving, strenuous activities and sports. You may also require physical therapy to help with range of motion for your head and neck, particularly if you were experiencing numbness and weakness prior to surgery. Though you may notice an immediate improvement in symptoms following surgery, it can take up to a year of healing and therapy for some patients to achieve maximum symptomatic relief.
Why Choose Neurosurgeons of New Jersey
The surgeons at Neurosurgeons of New Jersey are Chiari specialists who have helped develop a novel minimally invasive Chiari decompression approach. As a result, they are able to offer Chiari malformation patients an innovative treatment option that results in reduced pain and recovery time.
Neurosurgeons of New Jersey is the largest sub-specialized neurosurgical practice in the Tristate area. Each surgeon within the practice is focused on a particular subset of neurosurgical conditions and provides expert treatment in his or her area of focus. With cutting-edge technology and a patient-centric philosophy, the surgeons at Neurosurgeons of New Jersey are at the forefront of patient care and innovation, pioneering advanced techniques such as minimally invasive Chiari decompression and treating each patient’s individual needs with the utmost care.