So, I wanted to make a post to explain what the surgery entails..
I found this on csfinfo.org -
SURGICAL OPTIONS
All surgical interventions for Chiari I involve creating more room in the posterior fossa and foramen magnum to relieve the hindbrain compression. The patient is positioned prone (face down) on the operating table with the head in a fixation device. Incision is made in the midline, and the muscles and soft tissues are separated. Bone is exposed from the occiput to the top of the C2 vertebra.
- Bony decompression: The simplest option is bony decompression only. After exposing bone, a portion of the occiput and the posterior arch of the C1 vertebra are removed. The dura and underlying brain are not disturbed. This operation is performed by a minority (but a growing number) of surgeons. Most believe that expansion of the dura is also needed.
- Bony decompression with duraplasty: This technique is probably the most common method of Chiari I decompression. Bone removal is performed as above, after which the dura is opened. Some surgeons take great care not to disturb the underlying arachnoid membrane, while others open this layer as well. Leaving the arachnoid intact may prevent the CSF from leaking out, thus presumably decreasing the incidence of aseptic meningitis and pseudomeningocele. A graft is then sewn to the dura, effectively expanding the posterior fossa. Materials used for grafting include autologous tissue (fascia from patient’s own tissues), bovine pericardium, and a variety of synthetic materials. It is not known what the best material to be used for duraplasty is.
- Tonsil resection or shrinkage: In addition to opening the bone and dura, some surgeons prefer to address the tonsilar descent directly. This can be done by either applying bipolar electrocautery to the tonsillar tissue, causing it to shrink, or by resecting the tonsils. In either case, the goal is to ensure that there is no obstruction of CSF flow out of the 4th ventricle.
- Other options: Several other surgical strategies are employed to assist in a Chiari I decompression. Some centers use ultrasound to visualize the movement of the tonsils with the cardiac and respiratory cycles, or to visualize the flow of CSF before and after decompression. This can be used as an aid to determine whether dural opening or tonsillar shrinkage is necessary. In addition, various combinations of the above procedures are sometimes used. For example, some surgeons will open the dura, shrink the tonsils, and close the dura without a graft. Others use endoscopy to shrink the tonsils through a small skin incision.
CONCLUSIONS
When a Chiari I malformation is severely symptomatic, causes neurological deficits, or is associated with syrinx formation, the treatment is surgical. All options for surgery have a common goal of expanding the posterior fossa allowing normalization of CSF through the 4th ventricle and foramen magnum. This goal can be accomplished in many ways, from simple bone removal, to duraplasty and tonsillar resection. So far, no one method has shown superiority over the others
The first doctor I saw, explained to me that I would most likely need option #3 because of how far my brain is herniated into my spinal column.
Here are a couple of pictures after surgery.
Yeah, doesn't sound fun at all. No thanks! I'm praying I don't have to go through the surgery.
