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Almost all surgeries for CM and SM happen in the prone (face down) position. The neurosurgeon clamps the skull in place to keep the surgery site very steady. This may cause the patient some pain at the sites (usually three) where the pins of the skull clamp press into the skin. The patient will not be aware of this clamp, since it is put on after the patient is asleep and taken off before the patient wakes from general anesthesia. The surgery takes about four hours.
The incision for Chiari surgery is from the lower part of the back of the skull to the upper part of the neck and straight down the middle. The procedure usually is quite painful due to muscle being pulled back and the cutting done to perform the surgery.
Surgery can be painful and has some risks. The patient usually spends the first night in the intensive care unit (ICU). During this time, pain is usually the biggest issue and the patient is closely watched for neurological setbacks. Other risks include CSF leakage, pseudomeningocele, bleeding and infection. A pseudomeningocele occurs when CSF leaks from the spinal sac and builds up under the skin.
After the first night in ICU, it is expected that the patient will be moved to a room on the neuroscience floor. This will allow three to four days of care, pain control and the first phase of recovery. The first few days after surgery, pain medications and muscle relaxers are used to ease pain and discomfort. The patient and family need to realize the doctors are limited in the amount of pain medication they can provide.
Too much pain medication could cause other setbacks and complications. For example, a patient who is overly drowsy due to too much pain medication can get pneumonia. Such a patient also does not get out of bed to walk, thus becoming prone to setbacks from too much bed rest. The doctors must carefully adjust the level of medication to balance the patient’s comfort with safety. It is important that the patient appreciates the balancing act the doctor does in deciding pain medicine doses.
When the patients leave the hospital, they can plan on about six weeks of rest at home to recover. After surgery, most neurological symptoms are expected to go away. Pain should subside in the first two to three weeks. Some patients have constant surgical pain that may last several weeks or months after surgery. They must be prepared for this.
During this time the patient should walk and get plenty of rest. However, the patient should refrain from athletics, strenuous exercise, lifting objects heavier than 5 pounds, work and school for the six weeks, or as determined by the doctor. The patient may shower, but should avoid bathtubs, whirlpools and swimming pools until cleared by the doctor. Patients with Steri-Strips must cover the incision as directed by the doctor. The patient or caregiver may remove the tapes when directed. If tapes get wet, they can be patted dry or dried with a hair dryer on a cool setting. Once the patient is cleared to get the incision wet, gently scrub the incision to exfoliate, but do not scratch the incision. The patient may resume driving when completely off narcotics and when head motion is good, as declared by the doctor.