About Transnasal / Transoral Decompression
In most individuals, the cerebellum resides in a section of the skull near the back of the head. For individuals who have Chiari malformation, however, the cerebellum doesn’t fit entirely inside the skull and instead extends downward into the spinal canal, creating pressure on the brain and the spinal cord.
The most common surgical approach for Chiari malformation is posterior fossa decompression performed through an incision in the back of the neck. Sometimes, however, a Chiari malformation is accompanied by other skull base anomalies resulting in compression of the brain stem originating from the front side of the skull. In these complex cases, it may be necessary to access the affected area through the mouth or nasal passages. This kind of surgery is known as transoral (through the mouth) or transnasal (through the nose) decompression.
Goal of Transnasal / Transoral Decompression
The goal of transoral/transnasal decompression is to repair bony abnormalities at the base of the skull or upper spine, making more room for the cerebellum. Transoral/transnasal decompression may be followed by additional surgeries to the back of the neck to further reduce the pressure and prevent further damage.
How Transnasal / Transoral Decompression Is Performed
Before Surgery
Intubation is performed before transoral decompression. A flexible plastic tube, placed inside the windpipe, is used to administer anesthesia and to help maintain an open airway during the surgery.
Because correct orientation is critical to transoral/transnasal decompression, a special positioning system is used to hold the head in place. Neuromonitoring is also used to help the surgical team assess your condition throughout the experience.
To prevent infection, you will also be given antibiotics.
During Surgery
During transoral/transnasal decompression, the surgeon reaches the affected areas of the skull and spine by entering through the mouth or nasal passages. To maximize access special retractors are used to retract the soft tissues and endoscopic equipment may be used for visualization purposes.
A small incision is made in the rear of the mouth or nasal passages using specialized surgical tools. The soft tissues and muscles underneath are then gently separated to reveal the targeted areas, at which point a high-speed cutting burr is used to remove small areas of bone to create more room and relieve the pressure. Small sections of muscle or other soft tissue may also be removed.
Once adequate decompression is confirmed, the area is cleaned with an antibiotic solution and the wound is closed using sutures. A feeding tube is also inserted.
Recovery Timeline
Swelling and soreness are normal following transoral/transnasal decompression surgery. You should expect to remain intubated until the swelling has subsided, generally 24-72 hours. Pain medication will be given to help with the discomfort.
For the first 3-5 days after surgery, you will be provided nutrition through the feeding tube. Once the tube is removed, you’ll be able to progress from liquids to soft foods and finally to regular foods over the course of approximately two weeks.
The length of time at the hospital may vary, but generally is around a week. Once you return home it is important to continue caring for your body throughout the recovery process. A brace will be provided to help immobilize the spine as it heals and you should take care to avoid any rapid or strenuous motions of the neck, including activities such as driving, sports and so forth.
While some relief from symptoms may be noticed shortly after surgery, improvement is often incremental, sometimes taking as long as a year to be fully realized.
Why Choose Neurosurgeons of New Jersey
Deciding to undergo surgical treatment for Chiari malformation can be stressful. Neurosurgeons of New Jersey is committed to making the process as comfortable as possible through an emphasis on communication, cutting-edge technology and truly patient-focused care.
We are one of the largest sub-specialized practices in the tri-state area and are uniquely suited to meet the specific needs of Chiari malformation patients. You’ll meet with surgeons who are focused exclusively on treating these specific kinds of conditions and have extensive experience in the highly sensitive techniques required for success.
Throughout your interactions with Neurosurgeons of New Jersey, you can expect to be treated with the kind of care and professionalism that has earned us a reputation as one of the Northeast’s premier neurosurgery centers.