CHIARI DECOMPRESSION

What is Chiari Decompression Surgery?

Chiari decompression surgery refers to a surgery that helps to widen the foramen magnum and reduce pressure on the brain by removing the bone at the back of the skull (Siasios, Kapsalaki, & Fountas, 2012). Usually, this process helps to treat Chiari malformation. Chiari malformation refers to a structural defect of the cerebellum where the cerebellar tonsils protrude into the spinal canal. This ultimately creates pressure on the brainstem and blocks the flow of cerebrospinal fluid (CSF), which acts as a cushion for the brain and spinal cord. The blockage of CSF affects normal brain and spinal cord function and causes fluid to collect in the spinal cord (syringomyelia) or brain (hydrocephalus). Chiari malformation can affect both adults and children.

Chiari malformation causes neurological problems such as headache, neck pain, arm and leg numbness, dizziness, speech and vision problems, swallowing difficulty, impaired thinking etc. Therefore, Chiari decompression surgery helps to relieve the compression, control the progression of changes in the brain and spinal canal, and restores the normal flow of CSF within the brain. This also helps to cease or stabilize the symptoms produced by Chiari malformation. By using this surgery, neurosurgeons remove the small section of bone in the back of the skull and create more space for the cerebellum. Without decompression surgery, symptoms will progress and may worsen.

Conditions for a Chiari Decompression Surgery

Neurosurgeons perform Chiari decompression surgery to relieve the excess CSF from the brain and spinal cord. Basic reasons to perform this Chiari decompression surgery includes the following:

  •     To relieve pressure from the brainstem and spinal cord
  •     To restore the normal flow of CSF
  •     To control the progress of symptoms

Benefits and risks of Chiari Decompression Surgery

As with any surgery, Chiari decompression surgery comprises some risks and complications. These include (Pennypacker, 2019):

  •     Excessive bleeding
  •     Infection at the site of incision
  •     Head and neck pain
  •     Leakage of the cerebrospinal fluid (CSF)
  •     Pseudo-meningocele (Accumulation of CSF under neck tissues)
  •     Damage of the brain and nerve

Who is a candidate for Chiari Decompression Surgery? 

In general, patients with Chiari type 1 Malformation require Chiari decompression surgery. Neurosurgeons will examine the clinical presentation of the patient carefully before recommending him for this surgery. Surgical recommendations depend upon the training and experience of a neurosurgeon as well as the patient’s condition. Patients may qualify for this surgery if they possess (Taricco & Melo, 2008)

  •     Abnormal accumulation of CSF in the spinal cord and brain
  • Obstruction of the normal CSF flow within the brain and spinal cord due to Chiari malformation Type 1

How does a Spinal Surgeon perform Chiari Decompression Surgery?

Chiari decompression surgery requires an expert surgical team led by an expert neurosurgeon, with an anesthesiologist and nurses, to perform successfully. It requires almost 2 to 3 hours to complete successfully. The procedure includes (Shah, Dhar, Elsanafiry, & Goel, 2017):

  •   Patients will lie on the operating table under general anesthesia.
  • Neurosurgeon will hold the head in position during surgery on the table by using a 3-pin skull-fixation device.
  • Later, neurosurgeons will make a skin incision (3 inches long) through the neck muscles into the middle of the neck to see the skull and top of the spine.
  •     Neurosurgeons will perform the suboccipital craniectomy to remove a small section of the skull at the back of the head. In some cases, neurosurgeons remove the bony structure of the C1 vertebra (laminectomy). This helps to expose the protective covering of the brain and spinal cord (dura).
  •     The removal of the bone relieves the compression of the cerebellar tonsils and restores the normal flow of cerebrospinal fluid.
  •     Next, the neurosurgeon exposes the dura to view the tonsils and cisterna magna. 
  •     Depending on the size of herniation, neurosurgeons perform electrocautery to burn away and shrink the stretched and damaged tonsils. This shrinkage ensures the normal flow of CSF out of the 4th ventricle.
  •     Later, neurosurgeons use a patch of synthetic material or the patient’s own pericranium to suture the dural opening and cover the cerebellum. This patch enlarges the dura and the space around the tonsils. This suture helps to prevent leakage of cerebrospinal fluid.
  •     Finally, neurosurgeons suture the neck muscles and skin to close the incision.

What Does Recovery from Chiari Decompression Surgery Look Like?

The outcome of Chiari decompression surgery depends upon the severity of the Chiari malformation and previous brain or nerve injury. This surgery helps to restore the normal flow of the CSF and relieves the compression of the spinal cord. Patients need to stay in the hospital for 2 to 4 days after surgery. Patients need to go back to the hospital after 10 to 14 days of surgery to remove the sutures and check their recovery (Sabba, Renor, Ghizoni, Tedeschi, & Joaquim, 2017). Recovery from this surgery varies from 4 to 6 weeks, depending on the general health of the patient. Neurosurgeons suggest a follow-up MRI of patients after 6 months of surgery. For any information, please contact us at any time.

References

Pennypacker, N. (2019). Journal of Sports Medicine and Allied Health Sciences : Official Journal of the Ohio Athletic Trainers Association Surgical Interventions for the Treatment of Chiari Malformation Type I Surgical Interventions for the Treatment of Chiari Malformation Type I. 5(1).

Sabba, M. F., Renor, B. S., Ghizoni, E., Tedeschi, H., & Joaquim, A. F. (2017). Posterior fossa decompression with duraplasty in Chiari surgery: A technical note. Revista Da Associacao Médica Brasileira, 63(11), 946–949. https://doi.org/10.1590/1806-9282.63.11.946

Shah, A. H., Dhar, A., Elsanafiry, M. S. M., & Goel, A. (2017). Chiari malformation: Has the dilemma ended? Journal of Craniovertebral Junction and Spine, 8(4), 297–304. https://doi.org/10.4103/jcvjs.JCVJS_138_17

Siasios, J., Kapsalaki, E. Z., & Fountas, K. N. (2012). Surgical Management of Patients with Chiari I Malformation. International Journal of Pediatrics, 2012, 1–10. https://doi.org/10.1155/2012/640127

Taricco, M. A., & Melo, L. R. S. (2008). Retrospective study of patients with Chiari malformation submitted to surgical treatment. Arquivos de Neuro-Psiquiatria, 66(2 A), 184–188. https://doi.org/10.1590/S0004-282X2008000200008

 

ABOUT LONGHORN BRAIN & SPINE

Founded on Excellence

Founded by Neurosurgeon, Dr. Grant Booher, Longhorn Brain and Spine focuses on a patient-centered approach to alleviating North Texans from Neurological and Spinal Pain.  Dr. Booher and his clinical team believe in exhausting all non-invasive protocols first and if needed, employing the least invasive procedures necessary to treat the patients.

Our Beliefs

Dr. Booher believes in a conservative, individualized and holistic approach when it comes to his patients. He prefers exhausting all nonsurgical options and proudly offers the least invasive techniques when clinically indicated. He strives to treat every patient like a member of his family. During his free time, he and his wife enjoy watching sports, listening to Texas country music, and traveling.