Hello everyone!
About 3 years ago I had a decompression and laminectomy of C1 and C2. My neurosurgeon at that time said I would feel 80% better. . . YIKES. . . Only feel 20% better, if that. . .
Recently, I went to a new neurosurgeon (pediatrics), and she has done both Chiari surgeries on children and adults. Her impression was that the 1st surgeon did not complete the surgery, or that he was just being extremely cautious in what he was doing.
Her opinion (and I had a 2nd opinion to confirm - at Mayfield Chiari Clinic in Cincinnati) . . . that I needed to have completely removed the tonsils at the back of the head as well as a bovine (duraplasty) covering to keep the brain lifted. . . .My 1st NS advised me that the duraplasty would be not a smart idea. . . ???
Whew!! I am a little nervous about having this done, but, I cannot keep going like this - so, so much pain . . . . . .
Has anyone had their tonsils removed as well as the duraplasty (bovine covering) put in place????
I appreciate your advise!!
Yes, for me it feels like someone hit me with a 2x4 also. . . . right sided pain, where I'd like to pull my right eye out, since there's so much pain and vision is poor anyways. . .
Just really confirming I guess that yes, a 2nd surgery may be the option. . . According to my neurosurgeon, there will be MORE surgeries. . . we are not done!! Oh joy!!!
Well, do take care, Ella
The duraplasty is pretty debatable and becoming less common. It appears that there is more often than not natural retraction.While there isn't a lot of numbers, it appears that duraplasty carries a higher rate of complications. There is no difference in the initial outcomes of the two operations. Even Dr Trumble who pretty much does the dura plasty everytime admits its isn't necessary for most patients. Its essentially a judgement call because there just isn't enough data either way.
FWIW significantly lowering the risk of a fluid leak which is and can be a very serious complication is worth the risk of having to do the second surgery to toughly half of NS. Rember the ONLY goal of surgery is ultimatley to restore natural CSF flow. There is virtually no evidence that retraction of the tonsils will result in improvement of symptoms if flows are normal. (their may be other reasons to do the surgery and other risks to consider of course)
Anyway this is a great discussion: http://www.chiarisupport.org/forum/topics/second-surgery-with-durop... Dr. Trumbles comments near the end are very helpful.
Its pretty easy for a second opinion to speak with 20 -20 hind-site, I would consider that moving forward. If you are feeling particularly naughty you can ask them if the would feel the same way if you had a post op CSF leak or infection which of course would go directly to the brain as the protective dura would have been opened............
My surgeon, Dr. Holtzman has been doing good decompression surgeries for a very long time. He is extremely knowledgeable and published. I was asking him many questions about the duraplasty because I was very nervous about it. He said in all his years, the only 2 times he saw patients who came to him with failed surgeries were the only 2 that he saw without duraplasty. He told me…and I absolutely believe this…that there is only going to be a leak if the patch isn’t sewn on extremely well. Doctors don’t like to tell you things like “if it fails I probably didn’t sew the patch on well”. I can show you the research I found to back this up, so my concern became which patch to use. My 1st choice was the skin graft. 2nd was bovine. But I trusted my surgeon at this point to make the decision. .of course it is synthetic. .the 1 I didn’t want…but again, it’s important to have a surgeon you fully trust…or move on!
Additional studies (published in the same source) indicate a symptomatic pseudomeningocele, significantly decreases the likelihood of a full recovery. Pseudomeningocele of course being the most common adverse event. There are studies indicating that at 18 days the rate of pseudomeningocele is closer to 18%. So I guess its a matter of choosing your study as there isn't enough data to make a clear distinction. As there are no cohort studies available, deciding which study best fits you is even more difficult. It is probably the most difficult decision a patient needs make. The pro surgery advocacy groups don't make it any easier.
http://www.conquerchiari.org/subs%20only/Articles%20%2714/pseudo-ne...
Heres is a pretty good meta-analysis that determines statistically its a wash which way to go
http://www.conquerchiari.org/subs%20only/Volume%206/Issue%206(4)/Meta-analysis%20dura%206(4).html
Well, you are not feeling much better, your surgeon feels strongly about it and it was confirmed at the mayfield chiari clinic, 1 of the most respected chiari institutions around. I would think there has to be a reason you are barely feeling better. Why don't you write down every question you have about this and go back just to discuss your concerns.