Chiari Malformation Surgery
For children experiencing symptoms of and who have been diagnosed with
chiari malformations, the treatment is surgery to create more space for the brain and spinal cord. Without surgery, symptoms will continue and may worsen.
Risks of surgery include excessive bleeding, cerebrospinal fluid leak, infection, no relief of symptoms, paralysis, problems swallowing, abnormal eye movements and anesthesia complications. The family and the neurosurgeon decide if surgery is the best option. They base their decision on whether the symptoms interfere with the child's ability to function well.
Should my child and I do anything to prepare for the surgery?
To help us prepare for a successful surgery, please share with us your child's full medical history. Please report:
- any bleeding disorders within the family
- any medications the child is currently taking
- any medication allergies
Please notify us if your child has a known allergy to latex (rubber). Any unexplained problems with surgery, watery eyes, sneezing or wheezing while playing with balloons may be due to a latex allergy. Anyone who has had multiple surgical procedures might have such an allergy.
Day of the Procedure
A doctor called an anesthesiologist will discuss with you methods of pain control appropriate to your child's size and age. This doctor will obtain a thorough history of your child's past anesthetics as well as family reactions to general anesthesia. The day of the surgery, please be prepared to offer this information; it is very important in preventing possible reactions to anesthetic agents that may be used during the surgery.
Before coming to the hospital, please read the explanation that follows. If your child is old enough to understand, please explain what will happen before, during and after surgery using familiar terms.
Pre-operation checklist
1. Please mark clearly on your calendar the date, time and arrival time for your child's surgery. Surgery for patients who arrive late may have to be rescheduled. Please make arrangements for reliable transportation.
2. Please be sure you understand the eating and drinking instructions. Failing to follow these directions may result in the postponement of the surgery.
Children younger than 12 months
- Stop solid baby foods, cereal and formula six hours before surgery and restrict your child's diet to clear liquids
- Stop clear liquids and breast feeding four hours before surgery
Children older than 12 months
- Stop solid foods, milk, juices, candy, gum, only clear liquids after midnight the night before surgery
- Stop clear liquids four hours before surgery
Clear liquids are fluids you can see through:
- Water
- Pedialyte
- Jell-O
- Sprite
- Popsicles
- Clear broth
- Breast milk but not formula
If your child is younger than 12 months and is having surgery in the afternoon, he or she may have a light breakfast (cereal, toast, a clear liquid) up to eight hours before surgery. Please do not give your child meat or fried or fatty food for breakfast.
If your child takes daily medication for the heart, asthma or seizures, he or she needs to take the medication the morning of surgery. Your child should take medicine with a small sip of clear liquid. Do not give antibiotics the morning of the surgery as they can cause nausea and vomiting.
If you have questions about your child's medication, please call us, 513-636-4726.
3. Please inform us as soon as possible if your child develops a rash, fever, flu, cold or diarrhea or has been exposed to any communicable diseases like chicken pox, measles, mumps, etc. Surgery may have to be postponed if exposure was recent.
4. To avoid potential bleeding complications, please do not give your child aspirin, Motrin, Advil or Ibuprofen for two weeks prior to surgery, except as prescribed by your child's surgeon. If, by mistake, your child does take any of the medications listed, please let us know; because these medicines interfere with the blood's ability to clot, your child's surgery may have to be rescheduled. Your child may take Tylenol", an aspirin-free medicine, for pain or fever reduction.
5. Once your child's surgery has been scheduled, please schedule a physical with your pediatrician or family doctor for one to three days prior to surgery. This ensures that your child has no illnesses that may complicate surgery or anesthesia, and it also allows your child's doctor to know when your child is having surgery. The doctor must complete the preoperative history and physical form that you received when you and your child last visited us in neurosurgery. Please bring this completed form with you on the day of your child's surgery.
6. On the day before surgery, a nurse or technologist will take a sample of your child's blood for a complete assessment. The test referral center is on the first floor of Cincinnati Children's at 3333 Burnet Avenue. You must take the Pre-operative blood work form with you. Appointments are not necessary. The test referral center's hours of operation are Monday through Friday, 7 am to 8:30 pm, Saturday 8:30 am to 4:30 pm. If you have questions, please call the test referral center, 513-636-4461.
If your child's neurosurgeon has told you that your child will need a blood transfusion for surgery, you have the option of using the blood provided through Hoxworth Blood Center or of donating through Hoxworth's Directed Donor Program.
Hoxworth believes that the blood obtained through regular donations is as safe as blood secured through directed donors. This is especially true if the directed donor is not the parent or immediate relative. Women who have given birth within the past six months cannot donate blood. If you are interested in the Directed Donor program, please call Hoxworth at 513-451-0910 or 1-800-830-1091.
7. On the morning of your child's surgery, please wash with Phisoderm and then rinse your child's scalp for a full 10 minutes and body for five minutes.
8. Please arrive at the hospital one hour and a half before the scheduled time of surgery and bring your child's overnight bag, the form completed by your child's pediatrician (see 5.) and your insurance card. If you plan on spending the night with your child while he or she recovers with us, please remember your own overnight bag.
The hospital offers tours of the surgical facilities several days a week. This program is extremely beneficial for both child and family. Please call 513-636-8298 to make reservations for this educational program.
What happens during the surgery?
During surgery, a neurosurgeon makes a three to four inch cut at the very top of your child's neck at the back of the head. The neurosurgeon removes a small area of bone at the back of the skull (the occipital bone). Bone may also be removed from the vertebrae at the top of the spine. In many cases, this is all that is necessary to create enough space, but some children might still have too much pressure on the back of the brain. If that's the case, the neurosurgeon expands the tough fibrous layer of tissue that protects the brain and spinal cord (dura) allowing enough space to relieve the pressure. Not until after the first part of the surgery, when your child's vertebrae and part of the occipital bone are removed, will the neurosurgeon know whether opening the dura is necessary.
The surgery is performed under general anesthesia and will be scheduled for at least four hours. Surgery will last another 45 minutes if your child's dura needs to be opened to lessen pressure on the brain and to relieve symptoms.
What can we expect after the surgery?
Your child will spend at least 4 to 6 nights with us following surgery, and we will take care of special dietary needs (general anesthesia may cause an upset stomach). When your child tolerates regular food well, he or she will accompany you home for further recovery. Children usually return to full, normal activity in 12 to 14 days. Please refer to any of the following sections if you have concerns once you and your child get home.
Pain
If your child is under four years of age, please administer regular children's Tylenol" as directed for his or her pain. Children older than four years may be sent home with a prescription for Tylenol" with codeine.
Wound Care
Please wash your child's incision each day with a mild shampoo (see home care instructions for a child with
cranial incision lines).
Activity
For several days after surgery, your child will not feel like being active. Activity should be limited to quiet play for the first week after leaving the hospital. Further activity instructions will be given at your first post-operative visit.
Bathing
Your child should shower with mild baby soap or shampoo daily. A sponge bath with mild soap followed by rinsing with clean water is fine for smaller children. Please do not allow the wound to soak in the bath tub.
When should I call the doctor?
Please call the doctor, 513-636-4726 if you are concerned with you child's progress after surgery or if your child experiences:
- Temperature greater than 102oF
- Bleeding or drainage from the incision
- Confusion or excessive sleepiness
- Severe headache that does not stop with Tylenol" and rest
- Excessive vomiting (when nothing stays down)
Our office hours are 8 am to 4:30 pm, Monday through Friday. For evenings and weekends, please call 513-636-4200 and ask for the neurosurgeon on-call.
Rev. 3/06
