Different outcomes of Chiari surgery

[Guest guest]

Many patients like Chip had one only successful operation in their lifetime.

Others were not as lucky.

Why ?

For two main reasons:

* the surgery is the right one for that patient, but it is flawed by

complications;

* or the surgery has no complications, but is the wrong one for that

specific patient.

The list of the complications is long:

* CSF leak,

* Meningocele (= the dural patch inflates like a sail),

* Pseudomeningocele (= CSF leaks out of the dural patch and pools in

the soft tissues),

* Cervical instability (in case of extensive cervical laminectomies),

* Bacterial meningitis,

* Aseptic meningitis (it is not an infection, but an inflammatory

reaction),

* Soft tissue infection (i.e. MRSA),

* Excessive scar retraction,

* Intracerebellar Hemorrhage,

* Stroke (PICA and vertebral),

* Injury of brainstem or cranial nerves,

* Etc.

Sometimes there are no complications, but the surgery which was performed

was the wrong one for that specific patient.

Examples:

* If a Chiari patient has also a severe brainstem kinking by a

retroflex odontoid, the posterior decompression will aggravate such

condition;

* If a patient has an acquired Chiari secondary to hydrocephalus, or a

mass in the posterior fossa, the decompression will not address the main

problem, and the symptoms will recur;

* If a Chiari patient has an underlying upper cervical instability, a

C1 laminectomy will aggravate this condition;

* If a Chiari patient has an undiagnosed tethered cord, the standard

Chiari decompression will not address the main pathology.

* And more like that.

Any Neurosurgeon can open a book and learn about the standard operation.

Aneurysm surgery is definitively more technically complicated than a Chiari

decompression, and any neurosurgeon can clip an aneurysm. You draw the

conclusion.

The Chiari experts, on the other hand, can:

* Minimize the incidence of complications (remember: nobody is

perfect);

* Solve or " patch " the complications when they occur;

* " Smell " if there is something else cooking aside from the Chiari,

and adapt the surgical plan to the given situation.

Take home messages.

* Even in the best of hands, complications do happen;

* In Chiari, there is no " one-size-fits-all " surgery.

Happy New Year.

Paolo Bolognese, M.D.

The Chiari Center

Department of Neurosurgery

North Shore University Hospital

Manhasset (NY)

[Guest guest]

Ok, I like what I'm hearing from this doctor. Perhaps I'll need to get on

the waiting list after my neurologist appointment on the 10th.

Read my daily " Blahthings " at:

www.100megsfree4.com/blahthings/