When an individual exhibits symptoms of Arnold-Chiari malformation, doctors usually prefer the surgery route. This surgery is done with the aim of stopping the progress of the changes to the structure of the spinal canal and the brain. It also helps to alleviate the symptoms. Usually, when the surgery is successful, the pressure inside the spinal cord and the cerebellum is reduced so that the cerebrospinal fluid can flow normally.
One of the most common ways to deal with Arnold-Chiari malformation is removing a small part of the skull from the back, creating more space. As a result, it helps to relieve pressure and provides more space for the brain. In many patients, the dura, which is a protective covering of the brain, is surgically opened during the surgery. Sometimes, the surgeon may attach a patch to the dura mater to make it bigger, so that it can cover the brain. This patch can be harvested from the patient's own body, or it can be artificial.
In some patients, the surgeon may go ahead and remove a part of the spine to alleviate pressure on the spinal cord and also ensure the cord has adequate space within the spinal canal.
The surgical method adopted depends on the type of Chiari malformation and the associated symptoms. Hence, it keeps varying from person to person. Usually, if the person has hydrocephalus or syrinx, a shunt is also introduced to ensure drainage of excessive cerebrospinal fluid.
Right after the surgery, patients are carefully monitored, particularly during the initial 24 hours, to ensure they do not experience brainstem dysfunction. While this is rare, it is a complication that can arise after Arnold-Chiari malformation surgery. Typically, the patient spends the first night in ICU and by the end of day two, he/she is discharged from the hospital, provided they do not have any problems or complications.
It is normal to have pain at the site of the surgery along with muscle spasms. The pain and spasms can be controlled with the help of opiate analgesics and relaxants. At times, the pain can be alleviated with the help of a soft cervical collar. Nausea and vomiting are normal after the surgery, as they occur due to the anaesthesia.
After the surgery, the patient has to go for postoperative visits. During these visits, the doctors ask patients about any improvement in the systems. Furthermore, the site of the surgery is checked to ensure there is no leakage of cerebrospinal fluid or formation of pseudomeningocele. If there is a pseudomeningocele, the doctors use conservative methods to treat it and which thereafter disappears after a few months. If the pseudomeningocele is large in size, drainage or another surgery may be necessary.
Usually, in the first 2 to 3 weeks, patients are advised not to lift heavy objects and refrain from strenuous activities. Most patients recover completely after 4 to 6 weeks, but this varies across different patients. If the patient has had neurological problems prior to the surgery, he/she will need rehabilitation after recovery; and patients with syringomyelia need to have repeat MRIs to ensure the syrinx is no longer present after the surgery.
The results of the surgery are usually good. However, it all depends on the extent of the neurological problems the patient suffered prior to the surgery. Usually, patients with no or few neurological problems have the best outcome, while those with severe problems may not notice significant improvements.