Unsuccessful Chiari Surgeries – Possible Reasons and Treatment Options
Chiari malformation is a condition wherein the brain pushes back into the upper portion of the spinal canal. While some people may not experience any symptoms related to this condition, others may suffer from nausea, vision problems, headaches and tinnitus. Usually, surgery is the best option to alleviate the symptoms. One of the most commonly performed surgeries is decompression surgery, which involves removing a part of the skull to ease pressure on the brain. Typically, this surgery is quite effective; however, in some patients, it maybe unsuccessful.
Reasons for Unsuccessful Chiari Surgeries
According to neurosurgeons, there could be a number of reasons for failed Chiari surgeries. Typically, patients experience relief after the initial surgery, but the symptoms return within a short period of time. The reasons for failed or unsuccessful surgeries include:
Misdiagnosis on part of the neurosurgeon
Idiopathic intracranial hypertension
Existence of another condition along with Arnold-Chiari Syndrome
Postoperative scarring or adhesions can have an effect on the flow of cerebrospinal fluid
Tear in the dura surrounding the spine and brain could result in leakage of cerebrospinal fluid
Possible Treatment Options
If you have experienced a failed Chiari surgery, do not despair, as there are some treatment options that could alleviate the symptoms and ease pressure on your neck and brain.
MRI: It is imperative that you get an MRI done. This will check to see the flow of the cerebrospinal fluid and the position and shape of the cerebellar tonsils. Based on the MRI, the specialist will recommend a course of action.
Lumbar Puncture: If patients suffer from high intracranial pressure, the doctor will perform a lumbar puncture to reduce the pressure. In addition, patients also are put on medication to help lower intracranial pressure.
Shunts: In some patients, besides lumbar puncture, surgeons may also insert ventriculo-peritoneal shunts to drain out excessive cerebrospinal fluid and ease intracranial pressure. Here too, patients are put on prescription medication that helps to lower the pressure.
Surgical Removal of Adhesions: In some patients, it could become necessary to perform another surgery to remove scarring or adhesions, and ensure unobstructed flow of the cerebrospinal fluid.
Weight Reduction: Healthcare specialists have found an association between being overweight and having idiopathic intracranial hypertension. Being overweight causes an increase in cerebrospinal fluid, which then exerts pressure on the spine and the brain. In such patients, specialists may recommend dietary changes and exercises to reduce weight.
Tear in the Dura: Usually, if the surgeons find a tear in the dura that is causing the cerebrospinal fluid to leak, they will recommend complete bed rest. This can heal the tear. However, if the tear is large, it may necessitate a surgery.
Generally, patients will notice a reduction in their symptoms after a lumbar puncture or any of the other corrective treatment options. If pain remains an issue, it is best to opt for pain management to cope and deal with the pain. Some patients also find acupuncture to be extremely helpful in alleviating the symptoms of Arnold-Chiari malformation.