Decompression (surgery) information

If you're scheduled for surgery, or think it might be a possibility, then you might be wondering what goes on during the procedure. I took this off of my surgeon's website at: http://www.mayfieldchiaricenter.com/chiari_surgery.php

Step 1: prepare the patient

You will lie on the operating table and be given anesthesia. Once asleep, your head will be placed in a 3-pin skull-fixation device, which attaches to the table and holds your head in position during surgery. An inch wide strip of hair is shaved along the planned incision. The scalp is prepped with an antiseptic.

Step 2: make a skin incision

A skin incision is made down the middle through the neck muscles so that the surgeon can see the skull and top of the spine. The skin incision is about 3 inches long. The skin and muscles are lifted off the bone and folded back.

Step 3: remove bone

The surgeon removes a small section of skull at the back of your head (suboccipital craniectomy). In some cases the bony arch of the C1 vertebra may be removed (laminectomy). These steps expose the protective covering of the brain and spinal cord called the dura

Step 4: open the dura

Next, the surgeon opens the dura to view the tonsils and cisterna magna. Some surgeons perform a Doppler ultrasound study during surgery to determine if opening the dura is necessary. Sometimes bone removal alone may restore normal CSF flow.

Step 5: reduce the tonsils (optional)

Depending on the size of herniation, the stretched and damaged tonsils may be shrunk with electrocautery. This shrinkage ensures that there is no blockage of CSF flow out of the 4th ventricle.

Step 6: attach dura patch

A patch of synthetic material or the patient’s pericranium (a piece of deep scalp tissue just outside the skull) is sutured into place. This patch enlarges the dura opening and the space around the tonsils. The dural patch is sutured in a watertight fashion. The suture line is covered with a dural sealant to prevent CSF leak.







Step 7: close the incision




The strong neck muscles and skin are sutured together. A dressing is placed over the incision.







What happens after surgery?




You will wake up in the recovery area called the post-anesthesia care unit (PACU). Your throat may feel sore from the tube inserted to assist your breathing during surgery. Once awake, you’ll be moved to your room. Blood pressure, heart rate, and respiration will be monitored. If you feel nausea or headache after surgery, medication can be given. When your condition stabilizes, you will be discharged in the care of your family or a caregiver, usually 1 or 2 days after surgery.

The length of the hospital stay varies but is usually 2 to 3 days. When released from the hospital, you will be given discharge instructions:

Discomfort

• After surgery, pain is managed with narcotic medication. Because narcotic pain pills are addictive, they are used for a limited period (2 to 4 weeks). Thereafter, pain is managed with acetaminophen (e.g., Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., aspirin; ibuprofen, Advil, Motrin, Nuprin; naproxen sodium, Aleve).

• Regular use of narcotics can cause constipation, so drink lots of water and eat high fiber foods. Stool softeners (e.g., Colace, Docusate) and laxatives (e.g., Dulcolax, Senokot, Milk of Magnesia) may be bought over-the-counter.

• Ice packs for 20 minutes can help relieve neck and shoulder pain and muscle spasms. Muscle relaxants may be prescribed.

Restrictions

• Avoid activities that increase pressure in the head:

- Bending over, with head low
- Straining / pushing during a bowel movement
- Prolonged coughing (use a cough suppressant)

• Do not drive after surgery until discussed with your surgeon and avoid sitting for long periods.

• Do not lift anything heavier than 5 pounds (e.g., gallon of milk), including children.

• Housework and yard-work are not permitted until the first follow-up office visit. Avoid gardening, mowing, vacuuming and loading / unloading the dishwasher, washer, or dryer.

• Do not drink alcoholic beverages while on pain medicine. 

Activity

• Gradually return to your normal activities. Fatigue is common.

• Begin the isometric neck exercises and stretches as instructed.

• Walking is encouraged: start with short walks and gradually increase the distance. Wait to participate in other exercise until discussed with your surgeon. Avoid getting over heated. 

Bathing/Incision Care

• Shower and wash hair with mild shampoo after surgery unless otherwise directed by your surgeon.  Avoid water directly on the incision or rubbing the incision dry.  No tub baths, hot tubs, or swimming pools.

• Sutures or staples, if used, will need to be removed 7 to 14 days after surgery. Ask your surgeon or call the office to find out when.

When to Call Your Doctor

• Fluid may accumulate under the skin around the incision. A visible swelling that is soft and squishy may be a sign of cerebrospinal fluid (CSF) leakage. A clear sticky fluid may leak from the incision. Call the surgeon should any drainage occur.

• If you experience any of the following:

- A temperature that exceeds 101º F
- An incision that shows signs of infection, such as redness, swelling, pain, or drainage.
- Decreased alertness, increased drowsiness, weakness of arms or legs, increased headaches, vomiting, or severe neck pain that prevents lowering your chin toward the chest.