We went to John's pre-op appointment yesterday. At first we spoke with the Physician's Assitant. It was very clear that this 20-something, tall thin guy was handling his very first Chiari Malformation patient education pre-operative visit. He shuffled through the hubby's MRIs, found the ones that showed the appropriate part of the brain and cervical spine and began a very unconfident review of the diagnosis.
Let's just say that it became acutely aware to us that this kid was in over his head. We asked a question that was answered with "Uh…uh…lemme double check with the doctor". He scurried out of the room and we waited for a good 15 minutes. During this time, my husband looked at me sternly to say "Don't piss of my doctors". I think it was because I was laughing at this poor PA's misunderstanding of what the surgery was for and what entails.
When the rockstar doctor came in with his poor PA, he was a little guy with a large presence. He explained exactly what he was doing, while the three of in the room listened:
There will be an 8 to 10 inch incision made a little above the base of the skull and below C1. The doctors will dissect their way through the muscles to get to the skull and first cervical vibrate. The surgeons will shave the very base of the skull until it is the thickness of an egg shell, so that the bone can be taken out more easily and allow the brain more room. I imagine it's a lot like blown egg carvings you see around Easter time.
Then they are going to a similar shaving thing to about two inch section to his C 1 vertebrate. (vertebrate is the right word?) This just allows more room for the brain and all the goodness around it.
The covering on the brain will be opened. They will remove any adhesions (damaged/scar tissue) from the brain if found. They will then take a piece of pericardium (the covering found around the heart muscle) to cover the newly made opening in the skull. This helps keeps things in the right place. The pericardium is a strong, efficient and neat way to give everything support and make the brain happy.
They'll re-cover the brain, put in a lumbar shunt to drain away the excess fluids (because the inflammation that occurs form introducing foreign objects causes swelling and its not cool to swell in those areas). The shunt will not be permanent—it will be removed after about two days.
That's it. No fusion, which makes it easier. The hubby will have one hell of a headache for awhile and full recovery is about 3 months. People tend to start to feel better anywhere from 2 to 6 weeks. It's a wait and see how you do kinda thing.
We can still hit him in the back of the head since the area where the skull will be missing is rich in muscle. In short, he'll still be hard headed.
That's the short of it. Lots of risk, they aren't god, but infection, even the worst is generally okay to have. Just makes for a longer recovery. Physical therapy will be assessed in the hospital. The surgeon knows what he is doing, which is the most important part. And my husband is an asshole, so he'll follow orders.
Until then next time… we are on our way to the hotel and I will post again Thursday night.