General information: It’s a surgical procedure mainly used to remove the pressure at the craniocervical junction. it may also used to access this area for other reasons like tumour. It includes removal of small part of the skull, opening the foramen magnum and removal of the posterior arch of first cervical lamina (C1 laminectomy). In cases of Chiari malformation, opening and patching the meninges to give more space is a common approach for this condition.
The surgery is usually done under general anesthesia, prone position.
Risk of complications:
- Infection is less than 2 percent. It may affect the superficial tissues and skin, or may affect deep structures like skull bone (osteomyelitis), meninges(meningitis) or brain tissue(cerebritis or brain abscess). It also may lead to pus collection under the meninges (subdural abscess) or outside the meninges(epidural abscess). These complications are very rare, <1%.
- aseptic meningitis which is about 5% complication in Chari malformation.
- Significant sickness, nausia and vomiting.
- Bleeding which may lead to hematoma collection and pressure at the brain that may need further surgery.
- Cerebrospinal fluid (CSF) leak through the skin with small risk of meningitis.
- Neural tissue injury: the most serious complication may cause life changing consequences in form of weakness or paralysis of legs, sphincters, sensory or sexual changes. The risk is very variable according to the area of the brain targeted and the underlying cause that needed surgery.
- Injury to the blood vessels of the brain leads to stroke with a variable neurological deficit depending on the area of the brain affected.
- Seizure immediately or shortly after surgery.
- Failure to improve symptoms.
- General anesthetic complications (heart attack, stroke)
- Deep venous thrombosis/pulmonary embolism (clots in legs / lungs).
- Small risk to life.