Preparing for Chiari Decompression Surgery

November 20th, 2024 by Reza J. Karimi, MD

Chiari decompression surgery is a procedure that people seek to address their Chiari malformation symptoms. Chiari malformation can cause headaches, neck pain, numbness, and difficulty with balance and coordination for those with the condition. Some people address these symptoms with medication and physical therapy. For others, Chiari decompression surgery is the best option.

Chiari malformation comes in several types, and there are nuances to treating each type. Chiari malformation type 1 and type 2 are most common, whereas type 3 is a rarer pediatric form of the disorder.

Preparing for surgery is intimidating to many people. Whether you’re considering Chiari decompression for yourself or a loved one, it’s helpful to know some of the basics of the procedure and get a peek into the recovery process.

Chiari Type 1 vs. Chiari Type 2

Chiari malformation type 1 is the most common version of the disorder. It affects about one in every 1,000 people, though the actual number may be even higher because symptoms often take a long time to present. Type 1 presents as the extension of the lower part of the cerebellum into the hole at the base of the skull. The Chiari decompression surgery described below is designed to help patients with this type.

Chiari malformation type 2 is more common than type 3, but still not as common as type 1. Multiple and more complex surgeries are often needed to address additional conditions that present alongside type 2. Type 2 is associated with neural tube defects, spina bifida being the most common. With type 2, the cerebellum and the brain stem extend into the spinal canal.

What is Chiari decompression?

Chiari decompression is the process of relieving pressure and built up cerebrospinal fluid that causes symptoms.

Preparing for Chiari decompression surgery starts with understanding how the procedure works. First, your surgeon will make a small incision in the back of your neck. Then, they will remove a small piece of bone from the bottom of the skull and top of the spine. Removal of this bone is what creates more space for the cerebellum, since this condition is caused by the cerebellum extending into the upper spinal canal. (The cerebellum is the lower part of the brain.) When there is more space for the cerebellum, cerebrospinal fluid can flow more freely.

It’s also common for Chiari decompression surgeons to open up the covering of the brain, which is known as the dura mater. Again, some of the specifics of Chiari decompression surgeries depend on the patient’s specific type, but the surgeon may also want to sew a patch over the place where they opened the dura mater. The purpose of this is to make the covering larger so that the brain has more room. (Remember that Chiari malformation symptoms are largely caused by excess pressure from crowding.)

Is Chiari decompression considered brain surgery?

Chiari decompression is a type of brain surgery. While no surgery is necessarily a run-of-the-mill, everyday experience, there are actually a variety of common brain surgeries, ranging from biopsies to Deep Brain Stimulation (DBS). Chiari decompression has a craniotomy component (which just refers to the removal of that bone from the bottom of the skull) and is also known as posterior fossa decompression.

Surgeons perform Chiari decompression with the patient under general anesthesia. This means that you won’t be conscious and won’t feel any pain during the procedure. Your anesthesiologist will be a specialist who will explain the risks and possible side effects, and who will carefully review your medical history and prior reactions to anesthesia.

As with any surgery, there are risks. Infection and wound healing are risks with any surgery. In the case of Chiari decompression, fluid in the brain and cerebrospinal fluid leakage are additional complications that may arise.

What happens after Chiari decompression surgery?

An important part of preparing for surgery is understanding what happens after the procedure. Like many procedures, Chiari decompression surgery has different short-term and longer-term implications. You will have the chance to ask any questions you have before the procedure, and after Chiari decompression your surgeon will explain how everything went and the expected timeline for your recovery.

In the short term, you will probably stay in the hospital for one or three days following the procedure. You will also likely experience some pain and discomfort that you can manage with pain medication. Your doctor will recommend the best pain medication based on your personal history and pain levels.

It is recommended that you take it easy when you first go home, to allow your body to heal and focus on your recovery process.

Chiari decompression recovery

Recovery after a chiari decompression surgery comes in two phases, the immediate surgical recovery that occurs in the first two weeks, followed by a more sustained recovery and getting back to your usual daily activities over the next one to two months. Many of the initial chiari symptoms will improve in the first several weeks, followed by a more gradual but noticeable improvement over the next several months.

Physical therapy is an important component of the recovery process for many people. A physical therapist will work with you to explain and demonstrate specific exercises that will help you recover from the procedure. The main goal of physical therapy is to help patients regain strength and mobility.

Immediate recovery from Chiari decompression takes several weeks, but patients and their families should expect it to take several months before the full benefits of the procedure set in. After Chiari decompression, you will want to follow your surgeon’s instructions carefully and schedule all of the recommended follow-up appointments. These appointments may include imaging tests at specific intervals so that your doctor can examine the flow of cerebrospinal fluid and report back on how successful the surgery was.

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