Chiari Malformation Decompression Surgery: Post-Op Report

After many months of hardship, today's first patient came bounding into the clinic full of joy, thanks, and some minor neck pain. Her surgery, which had taken place three months earlier, left her unable to work and on a drug cocktail of pain medications. Her symptoms included massive headaches which rendered her immobile. She described them as "crushing". Her diagnosis was a Chiari Malformation, a condition where the cerebellar tonsils are displaced out of the skull area into the spinal area, causing compression of brain tissue and disruption of CSF flow.

http://www.mayoclinic.org/chiari-malformation/enlargeimage4476.html

The goal of the decompression surgery is to remove small sections of the bone at the back of the skull by the cerebellum to relieve pressure between the cerebellum and the brain stem and thereby allow a fluid path for CSF.

In this particular case, a patch graft, or dural graft, was instituted in place of the removed bone. There are several choices for what to use as a patch graft:  tissue taken from the patient's own body, bovine pericardium, dura taken from a cadaver, or a synthetic material.  Unfortunately, there is no clear agreement among surgeons on which material is best suited for the job. In this case, a synthetic material had been used. Today, increasing numbers of doctors are questioning the use of patch grafts in this surgery. Not only does the insertion of the graft increase the risk of infection, but also threatens the flow of CSF. In children, studies have shown that 80-85% of cases without the use of a patch graft are successful. However, there are no studies on the effectiveness of that method in adults.

During post-op, we began by taking the patient's vitals. Although her blood pressure was high, she seemed fairly normal. She complained, however, of intermittent neck pain and a lack of mobility in the neck. She has been going to physical therapy to increase that mobility for the past two weeks, and is now driving again because she can turn enough to see the rear-view mirrors. She has apparently shown significant improvement, so much, in fact, that she has taken herself off of morphine and other strong pain medications. She is preparing to return to work as soon as the opportunity presents itself.

A final comparison between a healthy chiari and a malformation that requires the decompression surgery:

http://www.healthline.com/galeimage?contentId=gech_0001_0001_0_00121&id=gech_0001_0001_0_img0056