What is Chiari Malformation Surgery?
For children having 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.
What Is Decompression Surgery?
Decompression surgery describes a number of different procedures. This type of surgery is used to remove the bone that is compressing the cerebellar tonsils. When successful, this reduces pressure on the brain and spinal cord. It also restores the normal flow of cerebrospinal fluid.
Decompression surgery is performed under general anesthesia.
- First, a small cut is made at the back of the head.
- The muscle is gently moved out of the way.
- A small piece of bone is removed from the bottom of the skull to create the extra space.
During surgery, the surgeon uses imaging technology to view the movement of the cerebellar tonsils and surrounding cerebrospinal fluid. This helps to determine whether the patient will benefit from more extensive decompression. If the space is okay, the surgery is over and the incision is closed.
If more space is needed:
- The surgeon makes a cut in the covering of the brain, called the dura mater.
- The surgeon may need to sew a patch over the opening to keep cerebrospinal fluid from leaking.
- Sometimes, the surgeon may shrink the cerebellar tonsils to make more room for the cerebrospinal fluid to circulate. These tonsils do not have any known purpose.
The surgical technique may vary. If your child has a syrinx or hydrocephalus, they may need a tube (shunt) to drain the excess fluid.
Decompression surgery can take two to three hours. Your child will typically go to the neurosurgical floor after surgery. Sometimes, your child will need to go to the pediatric ICU. Your child will experience pain and swelling after surgery. The neurosurgical team / pain management team will prescribe medicine to make them comfortable during the healing process.
After returning home, your child will need to avoid some activities for a couple of months. These include heavy lifting and contact sports. They should also avoid anything that causes neck strain, such as carrying a heavy backpack. During follow-up appointments in the clinic, your child's doctor will provide specific instructions.
Preparing Your Child for Surgery
The hospital offers tours of the surgical facilities several days a week. This program is very helpful for both children and their families. Please call 513-636-8298 to make reservations for this educational program.
You will need to do a few things to get your child ready for surgery. This checklist will help make sure you are prepared. View the pre-surgery checklist.
Your child will need pre op labs completed within six to eight weeks of surgery. Often times these labs can be completed after the office visit with the surgeon.
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 donating through Hoxworth's Directed Donor Program.
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, call Hoxworth at 513-451-0910 or 1-800-830-1091.
To help prepare for a successful surgery, share with us your child's full medical history. Please report:
- Any bleeding disorders within the family
- Any medications the child is currently taking, including any vitamins, herbal, or natural supplements
- Any medication allergies
Please tell us if your child has a known allergy to latex. 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 Surgery
On the morning of surgery, wash your child's head with tear-free baby shampoo and then rinse your child's scalp thoroughly.
Arrive at the hospital two hours before the scheduled time of surgery and bring your child's overnight bag, the form completed by your child's pediatrician, and your insurance card. If you plan on spending the night with your child while they recover with us, please remember your own overnight bag.
A doctor called an anesthesiologist will talk with you about methods of pain control appropriate to your child's size and age. This doctor will also ask you about your child's past anesthetics as well as family reactions to general anesthesia. Please be prepared to provide this information; it is very important in preventing possible reactions to anesthetic agents that may be used during the surgery.
During the Surgery
The surgery is performed under general anesthesia. The length of surgery is patient specific and you will be updated often during the surgery.
After the Surgery
Your child will spend about three to five nights in the hospital following surgery. When your child is able to eat regular food well and meets other discharge goals, they can go home. 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.
Please give acetaminophen (eg., Tylenol) as directed for your child's pain. If the pain is not relieved with acetaminophen, you may give your child oxycodone for incisional pain or robaxin or valium for muscle spasms.
Please wash your child's incision each day using the neurosurgery wound wash kit, which includes baby shampoo and sponges.
Activity After Surgery
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 postoperative visit.
Bathing After Surgery
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. Do not allow the wound to soak in the bathtub. Please keep wet hair off the incision. Once hair is dry, it is okay to have hair over top of the incision.
Call Your Child's Doctor If:
Call the doctor if you are concerned with your child's progress after surgery or if your child experiences:
- Temperature greater than 102° F
- Bleeding or drainage from the incision
- Confusion or excessive sleepiness
- Severe headache that does not stop with Tylenol and rest
- Excessive vomiting
Our office hours are 8 am to 4:30 pm, Monday through Friday. We can be reached at 513-636-4726.