Chiari Malformation surgery sometimes is necessary - Chiari Malformation is the result of a serious neurological defect where the cerebellum (lower part of the brain) pushes down and presses into the spinal cord. This extra pressure on both brain and spinal cord affects the flow of cerebrospinal fluid (liquid surrounding and cushioning the brain) and causes many symptoms which affect individuals in many different ways. Surgery for the condition is often not required in a chiari 1 malformation.
Chiari malformation is classified according to the parts of the brain that are affected and the severity of the condition. Chiari 1 malformation is the probably the most common and may not produce any symptoms in the affected individual until adolescence or later in life. It is the only type that can be acquired.
In many cases after a chiari malformation is diagnosed the normal procedure is to wait to see if symptoms become worse over time. It is quite often the case that medication and continued monitoring with MRI scans is all that is necessary. Sometimes symptoms can suddenly become worse as a result of a fall or even a sneeze and surgery may then be considered.
Often a neurosurgeon will conclude that the best course of action is surgery. The decision to operate needs to be thoroughly investigated and second, third and even fourth opinions should be sought. Regrettably there is no one independent measure to decide if surgery is needed and opinions vary with each surgeon especially in cases where symptoms are less severe.
The surgical procedure is usually referred to as decompression surgery and usually consists of removing a piece of bone from the skull. Possibly a piece of vertebrae from the top of the spine would also be taken out to relieve pressure and let the fluid flow normally. Part of the brain covering is removed and a patch is sewn in to enlarge the area. Finally some mesh is inserted to replace the piece of skull that was removed.
The usual operation takes approximately 4 hours but of course this varies. A stay in the intensive care unit overnight and about four days in hospital is typical. Rest time at home can depend greatly on the individual and recovery time from chiari malformation surgery may be anything from one month to three.
This is a question that needs to be thoroughly discussed with the surgeon so that the procedure is fully understood. The most likely problems with decompression surgery concern the difficulty when opening of the dura. This is where infection can occur and the patch may leak. In some cases the cerebellum may drop further into the spinal cord.
This is difficult to measure because every individual has a different interpretation of success. Which symptoms are alleviated and to what degree is a very different thing from one person to another. There is still a great deal of research to be done in this area. However the statistics that have been collected to date indicate that about 50 percent of patients with a simple Chiari 1 without syringomyelia are completely free of symptoms after surgery. Up to 30 percent report substantial improvement. On the other hand around 20 percent of cases result in failure and are likely to require further surgery. These statistics give a very approximate picture and every person needs to fully explore their chances of success with the surgeon.