Chiari Malformation Surgery Candidates Procedure Recovery and More
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nhs.uk/conditions/chiari-malformation/Chiari malformation. (n.d.).
aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Chiari-MalformationChiari malformation fact sheet. (2021).
ninds.nih.gov/chiari-malformation-fact-sheetCranio-cervical decompression for Chiari malformation: Patient and family information sheet. (2012).
sth.nhs.uk/clientfiles/File/Craniocervical%20decompression%20(updated%2014th%20Dec%202012).pdfGilmer HS, et al. (2017). Surgical decompression for Chiari malformation type I: An age-based outcomes study based on the Chicago Chiari Outcome Scale.
sciencedirect.com/science/article/pii/S1878875017312627?via%3DihubGoldschagg N, et al. (2017). Decompression in Chiari malformation: Clinical, ocular, motor, cerebellar, and vestibular outcome.
ncbi.nlm.nih.gov/pmc/articles/PMC5479925/Hidalgo JA, et al. (2022). Arnold Chiari malformation.
ncbi.nlm.nih.gov/books/NBK431076/Lane J, et al. (2021). Cost of Chiari I malformation surgery: Comparison of treatment at children's hospitals versus non-children's hospitals.
ncbi.nlm.nih.gov/pmc/articles/PMC7899285/Lee A, et al. (2014). Comparison of posterior fossa decompression with or without duraplasty in children with type I Chiari malformation.
ncbi.nlm.nih.gov/pmc/articles/PMC4104143/Vedantam A, et al. (2016). Thirty-day outcomes for posterior fossa decompression in children with Chiari type I malformation from the US NSQIP-Pediatric database [Abstract].
pubmed.ncbi.nlm.nih.gov/27392442/Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Sep 20, 2022 By Jill Seladi-Schulman, PhD Edited By Willow Banks Medically Reviewed By Seunggu Han, MD Copy Edited By Chris Doka Share this articleMedically reviewed by Seunggu Han, M.D. — By Jill Seladi-Schulman, Ph.D. on September 20, 2022
What to Know About Chiari Malformation Surgery
Medically reviewed by Seunggu Han, M.D. — By Jill Seladi-Schulman, Ph.D. on September 20, 2022A Chiari malformation (CM) is a type of structural change that affects the lower part of the brain. It’s most often due to a congenital condition that affects the shape or size of the skull. Congenital means that it’s present from birth. In CM, part of the cerebellum extends into the spinal canal. This can lead to increased pressure in this area, which affects the function of the cerebellum and brain stem. It also blocks the flow of cerebrospinal fluid (CSF). Surgery is one of the main treatment options for CM. This article will explore the surgical options for this condition, what the procedure is like, and more. Share on PinterestThe goal of Chiari malformation surgery is to relieve pressure on the lower part of the brain. Medical illustration by Bailey MarinerWhat are the surgical options for Chiari malformation
The most common type of surgery for CM is called posterior fossa decompression. This procedure creates additional space around the lower part of the brain, helping reduce pressure and relieve symptoms. In this type of surgery, a surgeon will make a small incision in the back of the head. Then, they will remove a little bit of bone from the bottom of the skull. This is called a craniectomy and helps make more space in the area. It’s also possible that the surgeon will remove part of the bone from the top of the spinal canal as well. This is called a spinal laminectomy. A surgeon can also use electrocautery to create even more space, if necessary. This method uses heat to reduce the size of the cerebellar tonsils, which are often the part of the cerebellum that has extended into the spinal canal.Additional procedures
CM is also associated with a variety of other medical conditions. As such, other types of procedures may be needed to address these as well:Hydrocephalus: In hydrocephalus, CSF builds up in the brain and can lead to dangerous increases in pressure. Doctors treat this in a couple of ways:shunting, in which a small tube is placed into the head to help drain excess CSF into the chest or abdomen, where the body naturally reabsorbs itthird ventriculostomy, where a small hole is made in one of the cavities of the brain, helping release trapped CSFMyelomeningocele: Myelomeningocele is the most severe type of spina bifida. Surgery is needed to reposition the spinal cord and close the opening in the back of the spine. This is typically done while a child is still in the womb.Syringomyelia: Syringomyelia is when a CSF-filled cyst forms in the spinal cord. It’s possible to drain these cysts by placing a shunt.Tethered cord syndrome: In tethered cord syndrome, the spinal cord has attached to surrounding tissues and cannot move freely. The resulting tension can lead to nerve damage. An untethering procedure can help address this.When is surgery for Chiari malformation needed
While CM is typically present from birth, many people do not develop symptoms until they’ve reached adulthood. At this point, the condition can be detected through imaging tests like MRI scans. Not everyone who has CM needs to have surgery. If you don’t have symptoms, your doctor may just want to monitor your condition periodically. Milder headache and neck pain due to CM may be treated using medications instead of surgery. When symptoms are more severe and interfere with daily activities, a healthcare professional may recommend surgery. Some examples of symptoms that CM may cause include:headache, which becomes worse when you do things like laugh, cough, or bend overneck paindizzinessmuscle weaknessatypical sensationstrouble with balance and coordinationdifficulty with speaking or swallowinghearing and vision problems The overall goal of surgery for CM is to reduce pressure on the brain and spinal cord. This helps ease symptoms and improve quality of life.What s the surgery like for a Chiari malformation
Posterior fossa decompression for CM happens in a hospital, and you will be under general anesthesia. That means that you’ll be asleep during the surgery. After you are sleeping, the surgery can involve the following basic steps:A portion of hair will be shaved from the area where the incision will be made.Your head may be placed into a device called a head clamp, which helps keep your head steady during surgery. If this occurs, it will involve a series of small punctures to secure the clamp to your skull.A surgeon will make an incision at the back of your head or top of your neck.The surgeon will work to expose the bones at the base of your skull and the very top of your neck.They will perform the craniectomy, and if necessary, the spinal laminectomy or electrocauterization.The surgeon may open the dura, which is the protective layer around the brain stem and spinal cord. This completes the decompression.The surgeon will close the incision. The total amount of time that the surgery takes depends on what exactly is being done. A 2016 study of children having CM surgery found that, on average, it took about 2.5 hours. After surgery, you’ll be moved to a recovery room until you wake up. Healthcare professionals will use equipment to monitor things like your heart rate, blood pressure, and blood oxygen. They will gradually remove this equipment as your recovery progresses. You’ll need to stay in the hospital for at least a few days after your surgery. A 2014 study noted average hospital stays of about 2 to 3 days, depending on the type of procedure. Remember that your hospital stay may be longer if you have a more complex procedure or if you experience complications afterward.What s the recovery like for a Chiari malformation surgery
It typically takes 6 to 8 weeks to recover from CM surgery. Yet your specific recovery time may vary, based on the exact type of procedure you had, your age and overall health, and whether you had any complications. When you wake up, you’ll likely find your head wrapped in a bandage. This helps protect the incision site and can also prevent you from scratching at it during your recovery. It’s also typical to have some symptoms like nausea, pain, or headache shortly after your surgery. The hospital staff will give you medications to help with these things. You’ll probably be able to get up and start moving around the day after your surgery. But you’ll need to avoid any strenuous activities or heavy lifting until 3 to 4 weeks afterward. When you’re able to leave the hospital, you’ll receive instructions on how to care for your incision, as well as how and when to take any prescribed medications. Be sure to follow these instructions carefully. Your surgeon will want to follow up with you in 6 to 8 weeks after your surgery to see how your recovery is going.What are the potential risks of a Chiari malformation surgery
As with any surgery, CM surgery comes with risks. Yet these are generally uncommon. Some of the risks associated with CM surgery may include:bleeding in or around the surgical siteinfection, including meningitisnerve damageparalysisstrokeCSF leakagepseudomeningocele, where a bulge that contains CSF develops under the skin at the incision sitehydrocephalusbrain sag, in which part of the brain sags away from the skull, leading to severe headaches Ask your doctor to discuss the various benefits and risks of surgery with you. You can then use this information to make an informed decision on how to move forward with treating your CM.How much does a Chiari malformation surgery typically cost
The cost of CM surgery can depend on many factors, including the:exact type of procedurespecific surgeon who does the surgeryhospital where the surgery happenstype of insurance coverage you have A 2021 study notes that the average cost of surgery for CM type I, the most common type of CM, was $13,716. The researchers also note that the cost was over $6,000 higher when the surgery happened in a children’s hospital. If you’re ever unsure about what you may be responsible for paying, contact your insurance provider prior to scheduling your CM surgery. They can give you detailed information about what is and what isn’t covered.What s the outlook for someone who s had a Chiari malformation surgery
Many CM surgeries have a good outlook. Yet this can depend on how severe your CM is. More severe types of CM generally have a poorer outlook. Age may also play a role in outlook. For example, a 2017 study found that children and adolescents undergoing surgery for CM type I had a better outcome than both younger and older adults. A small 2017 study of 10 people who had had CM surgery found that symptoms like headache, atypical sensations, and trouble with coordination and balance were effectively alleviated in most people. After surgery, the researchers did note that some people developed new eye movement dysfunction. This didn’t cause noticeable symptoms or concerns for these individuals. Not every person who has surgery for CM will experience complete relief of their symptoms. It’s also important to note that if nerve damage has already happened due to CM, surgery cannot reverse this. It’s also possible that some people will need more than one surgery for CM and any associated conditions. Your doctor will follow your recovery and let you know what to expect.Takeaway
Surgery is one of the main treatment options for CM. On a basic level, it involves the removal of bone from the back of the skull and sometimes the top of the spine in order to reduce pressure on the brain and spinal cord. CM surgery can help to ease symptoms in many people. However, some people may find that certain symptoms continue after surgery. Additionally, it’s possible you may need more surgeries in the future. Prior to scheduling your surgery, talk with your doctor about the different benefits and risks associated with the type of procedure being considered. They can help to give you an idea of what to expect. Last medically reviewed on September 20, 2022How we vetted this article
SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Chiari malformation. (2019).nhs.uk/conditions/chiari-malformation/Chiari malformation. (n.d.).
aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Chiari-MalformationChiari malformation fact sheet. (2021).
ninds.nih.gov/chiari-malformation-fact-sheetCranio-cervical decompression for Chiari malformation: Patient and family information sheet. (2012).
sth.nhs.uk/clientfiles/File/Craniocervical%20decompression%20(updated%2014th%20Dec%202012).pdfGilmer HS, et al. (2017). Surgical decompression for Chiari malformation type I: An age-based outcomes study based on the Chicago Chiari Outcome Scale.
sciencedirect.com/science/article/pii/S1878875017312627?via%3DihubGoldschagg N, et al. (2017). Decompression in Chiari malformation: Clinical, ocular, motor, cerebellar, and vestibular outcome.
ncbi.nlm.nih.gov/pmc/articles/PMC5479925/Hidalgo JA, et al. (2022). Arnold Chiari malformation.
ncbi.nlm.nih.gov/books/NBK431076/Lane J, et al. (2021). Cost of Chiari I malformation surgery: Comparison of treatment at children's hospitals versus non-children's hospitals.
ncbi.nlm.nih.gov/pmc/articles/PMC7899285/Lee A, et al. (2014). Comparison of posterior fossa decompression with or without duraplasty in children with type I Chiari malformation.
ncbi.nlm.nih.gov/pmc/articles/PMC4104143/Vedantam A, et al. (2016). Thirty-day outcomes for posterior fossa decompression in children with Chiari type I malformation from the US NSQIP-Pediatric database [Abstract].
pubmed.ncbi.nlm.nih.gov/27392442/Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Sep 20, 2022 By Jill Seladi-Schulman, PhD Edited By Willow Banks Medically Reviewed By Seunggu Han, MD Copy Edited By Chris Doka Share this articleMedically reviewed by Seunggu Han, M.D. — By Jill Seladi-Schulman, Ph.D. on September 20, 2022