Discuss success or problems with Decompression surgery with duroplasty after having Decompression without .
I did not have a duraplasty with my first decompression done at Johns-Hopkins in 2000. I was told by Dr. Jon Weingart (NS) that my ligaments and muscles were strong enough to hold my brain in place and that I could resume all previous activities prior to decompression that my body would limit itself! By 2003, I was exhibiting symptoms again was in quite a bit of pain. We had just adopted newborn and I attributed much of my symptoms to being a new mom again. However, my symptoms progressively worsened. I returned to said NS only to hear that he "wasn't into that type of surgery anymore" and said he could offer me nothing even though he told me that he no longer did decompressions without performing a duraplasty and a few other things that he said were now protocol for a decompression. due to not having had the duraplasty with the original decompression, my brain actually fell crushing my brainstem causing me to have to have a decompression revision, duraplasty, titanium plate with a craniocervical fusion, and eventually a VP shunt---->VA shunt. If I had had a duraplasty and possibly a plate to hold my cerebellum in place, I most likely wouldn't have had to have been fused (my head is in a fixed position forever. It does not move L, R, nor bend forward nor backwards!) I've been like this since my 3rd daughter was 2yo and she's now 10. She doesn't remember me any other way. I was a very active person. I was on a tennis team and I rode and showed horses. My life is much different now and I have very few pain free moments. This is just my experience. I know everyone is different, but your ligaments and muscles are not strong enough to hold your brain in place as once thought! I'm a perfect example of that. I had very strong muscles from being sooo athletic, but they were not strong enough to hold my cerebellum in place.
I can't stress enough getting more than one opinion.
My son had his 1st decompression surgery w/ duraplasty and 8 most later he had to have a 2nd decompression w/ duraplasty. After the 2nd surgery, he had a VP shunt placed. The day after he had it placed, he puked and didn't stop for an entire year later until they took out the shunt. He puked less now but still often and random. His NS said this may be a life long side effect from the brain surgeries. I am trying to find out if vomiting has happened to anyone else and why? The NS gives no definitive answer for it. It is very frustrating..
Laura,
Thank you for sharing your story. There are several Members that have extreme situations. Even though I didn't have the same issues I understand your Chronic Severe Pain 24/7. I often wonder if newly diagnosed Chiarians heard our stories, if they would want surgery so badly. I am not judging anyone and know every situation is different, but I don't think many realize the severity of post op symptoms and side effects of the surgeries. I would never wish my post op Chiari life on anyone.
Tracy Z.
I had a first surgery with no duraplasty. It was not successful. I did okay for the first few months. Then I started on a fast downward slide. By month 10 after the surgery, I knew I was in serious trouble. The muscles all over my body twitched constantly, my hands and feet were numb, I was in constant neck and head pain. I had muscle spasms so bad I could hardly turn my head. Sometimes I had trouble walking. I felt very weak. I could not get my neurosurgeon to take me seriously. He felt that my decompression was adequate. I requested an MRI to check on my brain. I later found out he never even read them. For the next four months my neuro health took a nosedive. I was in and out of the hospital, the twitching was non-stop, the pain was non-stop, my eyes hurt, I literally felt like I was going to have a stroke and die at any minute.
I finally got up the guts to confront my surgeon with my terrible MRI results (the report said things looked worse post-op than they did before the surgery) and he offered to re-do the surgery with the duraplasty. By that time, I had no confidence in him. He’d blown me off for almost six months while I’d been suffering, and all the while he’d had the MRI results right in front of him saying my brain looked awful. Needless to say, I did not let him cut me open again!
I found a new surgeon and had my decompression done again WITH the duraplasty AND the titanium plate. I am doing very well now! I know people toss this phrase around all the time, but I really think he saved my life. When he got in my head, there was evidence that I’d had more than one stroke, and there was necrotic tissue on the brain. My brain stem was so compressed it was turning white. My cerebellar tonsils were mangled-looking and smashed into my brainstem. In my case, having the decompression WITHOUT the duraplasty had a terrible impact on me. I got a huge build-up of scar tissue that pushed on the herniation, and put pressure on it, smashing it into the brainstem. I had myodural adhesions cleaned out (after my first surgery, I developed extensive painful adhesions between the neck muscles and the dura). It was just a freaking MESS in my head - and a lot of that was due to skipping the “invasive surgery” the first time. I am extremely happy I had my surgery re-done. Yes, it was awful and traumatic to have it done twice. It hurt way more to have the duraplasty and plate put in. But some patients absolutely NEED it.
BTW, I did not have a fusion with either surgery, and my herniation was 15mm.
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I have only had the one decompression surgery, but my symptoms were VERY severe and my herniation was at least 22mm. My surgeon was pretty aggressive in his approach, but apparently he always is although he is selective in his pt. anyway, I had a duraplasty using my own extra dura taken somewhere from the side of my brain. He said when he opened up the dura and performed the laminectomy on my C1&C2 vertebrae, that they saw the tonsils recede back up quite a bit. I am only 2 weeks post op but I have had ZERO symptoms at all after the first week. In fact, my strength and feeling in my hands came back immediately out of the OR. I was amazed. I did have worse chiari positional headaches a few days after the surgery but I haven’t had any for many days now. I had a tremendous sneezing fit this morning without even a twinge of pain. Imagine?! As I said before, I’m only 2 weeks post op but I feel tremendously better. The NP who removed my stitches today (21!!) said that they always have this result. I don’t know if its his luck, his selectivity, or he’s just that good. I honestly never thought I would feel “normal” much less GREAT again. I highly recommend getting the dura. See if you can have them use your own. I don’t know where you live, but my surgeon is in NYC at NY Presbyterian (Weill, Cornell) and his name is Dr Mark Souweidane. Not much in bedside manner, but he’s not a jerk by any means. Actually, I just remembered why I chose him. Here in NYC, he’s the guy everyone goes to to fix previously poor decompressions, or those who didn’t get good results. So if you’re in the area or can travel I HIGHLY HIGHLY reccomend him!! Good luck whatever you decide, but I would say YES to duraplasty. (Obviously I don’t know your situation, age, other maladies etc) even so… Best of luck!
Great recommendation Kat !! Thank you and I am very glad you are doing so well !!!
Toni,
Is your son on any medication or is he getting choked? Is it projectile vomiting or reflux? Have you gotten a second opinion? Sorry for all the questions. I just want to know how we can help your son.
Toni said:
My son had his 1st decompression surgery w/ duraplasty and 8 most later he had to have a 2nd decompression w/ duraplasty. After the 2nd surgery, he had a VP shunt placed. The day after he had it placed, he puked and didn't stop for an entire year later until they took out the shunt. He puked less now but still often and random. His NS said this may be a life long side effect from the brain surgeries. I am trying to find out if vomiting has happened to anyone else and why? The NS gives no definitive answer for it. It is very frustrating..
Toni,
Sorry you guys are going through this. I am 4 months post op and have not stopped vomiting either. When I’m not throwing up my nausia feeling is still there. I had leaking spinal fluid from my incission site 3 months post op. surgeon had never seen this before so late on after surgery. There is no pathway to the leak which is good and they said its old fluid pocket that filled after surgery. After my last leak they said the fluid filled pocket had gone. My vomiting left me too! I had the dura patch and was told all of these post op issues were prob because my body was trying to reject the patch. Looks like I won the fight and my body has finally accepted the new changes. Hope this helps! Good luck 
Finallyhavedx, what kind of patch do you have?
Kat said:
I have only had the one decompression surgery, but my symptoms were VERY severe and my herniation was at least 22mm. My surgeon was pretty aggressive in his approach, but apparently he always is although he is selective in his pt. anyway, I had a duraplasty using my own extra dura taken somewhere from the side of my brain. He said when he opened up the dura and performed the laminectomy on my C1&C2 vertebrae, that they saw the tonsils recede back up quite a bit. I am only 2 weeks post op but I have had ZERO symptoms at all after the first week. In fact, my strength and feeling in my hands came back immediately out of the OR. I was amazed. I did have worse chiari positional headaches a few days after the surgery but I haven't had any for many days now. I had a tremendous sneezing fit this morning without even a twinge of pain. Imagine?! As I said before, I'm only 2 weeks post op but I feel tremendously better. The NP who removed my stitches today (21!!) said that they always have this result. I don't know if its his luck, his selectivity, or he's just that good. I honestly never thought I would feel "normal" much less GREAT again. I highly recommend getting the dura. See if you can have them use your own. I don't know where you live, but my surgeon is in NYC at NY Presbyterian (Weill, Cornell) and his name is Dr Mark Souweidane. Not much in bedside manner, but he's not a jerk by any means. Actually, I just remembered why I chose him. Here in NYC, he's the guy everyone goes to to fix previously poor decompressions, or those who didn't get good results. So if you're in the area or can travel I HIGHLY HIGHLY reccomend him!! Good luck whatever you decide, but I would say YES to duraplasty. (Obviously I don't know your situation, age, other maladies etc) even so... Best of luck!
hi,i am getting close to my surgery, but every time i think i am prepared, i realize i dont know enough. can someone please tell me what "dura" is? & thank you Kat for the reccomendation, ive been desparately trying to find a 3rd opinion. My 1st was with an NS. my 2nd was with a specialist from the chiari center. The 2 opinions were very different,so needless to say, i want to see another NS who actually has alot of experience with this. Also, my 2nd NS was informative, but when i asked him what herniation was, he didnt explain it & said i dont have it & kinda dismissed it because i told him ive been heariing about it on my online support group. is it possible to have severe symptoms, a very large syryngomyelia & no herniation? any help is appreciated
I definitely know where you are coming from with that question, Tracy Z! Validation and the odds of giving me back the life I once had (or close to it) were what swayed me both at JHMC and at TCI. I did get much relief after the initial decompression and had I not had the first decompression at JHMC, I probably wouldn't have lived to have needed the second series of surgeries because my organs were quickly shutting down from the compression of my brain stem and lack of flow of csf. I so badly wanted to be the mom and wife I had been prior to my accident that I was willing to try anything to get out of pain and get some sort of life back --that didn't involve living in bed or in a hospital......
Our youngest daughter has a full time nanny. I am in bed 95% of the time and "there is nothing left that can be done for me at this time." I don't think my husband and I would change the decisions we made because we feel we were well informed at the time of our decisions....things have progressed and changed a lot since both of my brain surgeries (7 total) -- I feel everyone is different and has to make the choices they feel are right for them. We had exhausted all avenues and possibilities before conceding to surgeries. Did we think I would still live in pain 24/7/365? Definitely not, but that hasn't been the case. I do feel blessed to have an amazing, supportive husband and family. I have never applied for disability but I am definitely 100% disabled. With research and technology constantly changing, I still have hope that one day, there will be something or someone who can help me. I wouldn't wish my post op Chiari/IIH life on anyone either!
durapasty-bovine
plate(s)-titanium (one over duraplasty and one at the base of neck to connect titanium rods to fixate my head)
shunt-VA
TracyZ said:
Laura,
Thank you for sharing your story. There are several Members that have extreme situations. Even though I didn't have the same issues I understand your Chronic Severe Pain 24/7. I often wonder if newly diagnosed Chiarians heard our stories, if they would want surgery so badly. I am not judging anyone and know every situation is different, but I don't think many realize the severity of post op symptoms and side effects of the surgeries. I would never wish my post op Chiari life on anyone.
Tracy Z.
No he is not on any medication. Sometimes he'll wake up out of his sleep crying and then vomit. Other times he'll just say his belly hurts and then vomit. Then there are time where it is just out of no where for no apparent reason. He's 3yrs old now. He had projectile while he was a baby but not anymore. We are going to have him seen by a GI doc to see if its reflux. It's just a little to coincidental that he started vomiting the day after they put the shunt in. It leads me to believe that it was something to do with it/surgery.
TracyZ said:
Toni,
Is your son on any medication or is he getting choked? Is it projectile vomiting or reflux? Have you gotten a second opinion? Sorry for all the questions. I just want to know how we can help your son.
Toni said:My son had his 1st decompression surgery w/ duraplasty and 8 most later he had to have a 2nd decompression w/ duraplasty. After the 2nd surgery, he had a VP shunt placed. The day after he had it placed, he puked and didn't stop for an entire year later until they took out the shunt. He puked less now but still often and random. His NS said this may be a life long side effect from the brain surgeries. I am trying to find out if vomiting has happened to anyone else and why? The NS gives no definitive answer for it. It is very frustrating..
He had two leaks as well and had to have 2 revisions and 2 meningitis infections but never vomited then. I just don't get it. He will start school next year and I don't see how that's going to go well. He puked even if he cries and gets upset. The other times are just random.
Finallyhavedx! said:
Toni,
Sorry you guys are going through this. I am 4 months post op and have not stopped vomiting either. When I'm not throwing up my nausia feeling is still there. I had leaking spinal fluid from my incission site 3 months post op. surgeon had never seen this before so late on after surgery. There is no pathway to the leak which is good and they said its old fluid pocket that filled after surgery. After my last leak they said the fluid filled pocket had gone. My vomiting left me too! I had the dura patch and was told all of these post op issues were prob because my body was trying to reject the patch. Looks like I won the fight and my body has finally accepted the new changes. Hope this helps! Good luck ;)
There has never been a randomized control study(the gold standard) to definitely show which operation for Chiaris are best. Many neurosurgeons are concerned about the risk of CSF leak and therefore don't perform a duraplasty. I perform a duraplasty on all my non-syndromic patients(if you have an underlying skull defect, e.g. achondroplasia(dwarfism) or craniosynostosis, bony decompression alone is more reasonable in my opinion).
The medical reasoning is long but the short version is from 2 articles.
Neurol Sci. 2011 Dec;32 Suppl 3:S321-4.
Treatment for Chiari 1 malformation (CIM): analysis of a pediatric surgical series.
Valentini L, Visintini S, Saletti V, Chiapparini L, Estienne M, Solero CL.
Source
Department of Neurosurgery, Fondazione Istituto Neurologico C. Besta, Via Celoria 11, 20133, Milan, Italy. â– â– â– â– â– â– â– â– â– â– â– â– â– â– â– â– â– â– â– â– â– â– â– â– â– â– â– â–
Abstract
Children may present a peculiar picture of CIM, as syncopes and acute paraparesis. In a series of 99 children operated for CIM at FINCB there were no major surgical morbidity nor mortality. The preoperative symptoms improved more in this pediatric series than in the adult cases treated at the same institution in the same period; a reason could be the shorter duration of symptoms and another the children plasticity. An untreated nonsyndromic craniosynostosis was present in 10 cases. In our hands, the results of the limited extradural decompression were poor. In some CIM associated with psychiatric symptoms an unexpected improvement was observed after tonsilar resection. The associated Syringomyelia reduced in more than 80% of children and disappeared in a significant number. The rare associated tethered cord (5%) needed a double treatment, detethering by itself being insufficient to treat also tonsillar descent. The clinical symptoms are often more serious in children than in the adults, but the results of surgery, especially on the syrinx, are better.
Specfically, their experience that"the results of the limited extradural decompression were poor" mirrors my own experience. Additionally,
J Neurosurg Pediatr. 2008 Jul;2(1):42-9. Links
Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis.
Department of Surgery (Pediatric Neurosurgery), Dartmouth Medical School, Hanover, NH, USA. â– â– â– â– â– â– â– â– â– â– â– â– â– â– â– â– â–
OBJECT: Surgery for Chiari malformation Type I (CM-I) is one of the most common neurosurgical procedures performed in children, although there is clearly no consensus among practitioners about which surgical method is preferred. The objective of this meta-analysis was to compare the outcome of posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) for the treatment of CM-I in children. METHODS: The authors searched Medline-Ovid, The Cochrane Library, and the conference proceedings of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons (2000-2007) for studies meeting the following inclusion criteria: 1) surgical treatment of CM-I; 2) surgical techniques of PFD and PFDD being reported in a single cohort; and 3) patient age < 18 years. RESULTS: Five retrospective and 2 prospective cohort studies involving a total of 582 patients met the criteria for inclusion in the meta-analysis. Of the 582 patients, 316 were treated with PFDD and 266 were treated with PFD alone. Patient age ranged from 6 months to 18 years. Patients undergoing PFDD had a significantly lower reoperation rate (2.1 vs 12.6%, risk ratio [RR] 0.23, 95% confidence interval [CI] 0.08-0.69) and a higher rate of cerebrospinal fluid-related complications (18.5 vs 1.8%, RR 7.64, 95% CI 2.53-23.09) than those undergoing PFD. No significant differences in either clinical improvement (78.6 vs 64.6%, RR 1.23, 95% CI 0.95-1.59) or syringomyelia decrease (87.0 vs 56.3%, RR 1.43, 95% CI 0.91-2.25) were noted between PFDD and PFD. CONCLUSIONS: Posterior fossa decompression with duraplasty is associated with a lower risk of reoperation than PFD but a greater risk for cerebrospinal fluid-related complications. There was no significant difference between the 2 operative techniques with respect to clinical improvement or decrease in syringomyelia.
Note that the comclusion of this paper is that "there was no significant difference between the 2 operative techniques with respect to clinical improvement of decrease in syringomyelia." I've mentioned this before at the site so I apologize for repition for some but, the definition of a statistically signficant difference in medical is usually identified as a p value, e.g. p<0.05, meaning that the chance that the data could just be random is <5%. But look at the raw data. Syringomyelia decrase was noted in 87% in whom intradural exploration occured, as opposed to 56% with an extradural operation. Symptoms improved in 79% of patients with intradural exploration, as opposed to 65% with an extradural operation.
Reverse those numbers and look at the failure rate. for a syrinx, the failure rate for surgery is 13% for an intradural operation and 44% without. the risk of failure is >3x higher(but the patient volume wasn't high enough to reach statistical significance).
What does that mean? Can anyone tell you will medical certainty that an intradural exploration is necessary for each Chiari decompression? No. In fact, it is unnecessary in most patients. BUT...if you don't go intradural(and we haven't been able to delineate who really needs an intradural exploration and who doesn't), the surgical failure rate will be higher, possibly >3x higher. The surgical risk is also lower with an extradural operation(if you don't go into CSF pathways, you don't run the risk of a CSF leak).
It has always been my opinion that I would prefer to deal with things that should be in my control(a CSF leak), rather than things I don't control(CSF dynamics in a patient who had an extradural operation).
I would suggest that most neurosurgeons with large Chiari practices have come to similar conclusions. I would love to have medical certainty with these decisions. That data does not exist.
Hi Dr Trumble, I believe you are the Neurosurgeon that diagnosed my son with Chiari and Syrinx in Orlando 2011. He was just 14-15mos old then. We chose Dr Mark Iantosca at the Penn State Hershey Medical Center because my husband got stationed in Maryland right after we met with you. Have you had any experience with the vomiting in patients after surgery or VP shunt surgery? I don't seem to be getting any closer to an definitive answer for my son as to whey he vomits so randomly. Dr Iantosca's assistant had mentioned one time that maybe they nicked the 4th ventricle during surgery -as a cause for vomiting. He then quickly changed it up and now I don't get any info on that matter. Thanks for any insight!
Dr. Trumble said:
There has never been a randomized control study(the gold standard) to definitely show which operation for Chiaris are best. Many neurosurgeons are concerned about the risk of CSF leak and therefore don't perform a duraplasty. I perform a duraplasty on all my non-syndromic patients(if you have an underlying skull defect, e.g. achondroplasia(dwarfism) or craniosynostosis, bony decompression alone is more reasonable in my opinion).
The medical reasoning is long but the short version is from 2 articles.
Neurol Sci. 2011 Dec;32 Suppl 3:S321-4.
Treatment for Chiari 1 malformation (CIM): analysis of a pediatric surgical series.
Valentini L, Visintini S, Saletti V, Chiapparini L, Estienne M, Solero CL.
Source
Department of Neurosurgery, Fondazione Istituto Neurologico C. Besta, Via Celoria 11, 20133, Milan, Italy. lvalentini@istituto-besta.it
Abstract
Children may present a peculiar picture of CIM, as syncopes and acute paraparesis. In a series of 99 children operated for CIM at FINCB there were no major surgical morbidity nor mortality. The preoperative symptoms improved more in this pediatric series than in the adult cases treated at the same institution in the same period; a reason could be the shorter duration of symptoms and another the children plasticity. An untreated nonsyndromic craniosynostosis was present in 10 cases. In our hands, the results of the limited extradural decompression were poor. In some CIM associated with psychiatric symptoms an unexpected improvement was observed after tonsilar resection. The associated Syringomyelia reduced in more than 80% of children and disappeared in a significant number. The rare associated tethered cord (5%) needed a double treatment, detethering by itself being insufficient to treat also tonsillar descent. The clinical symptoms are often more serious in children than in the adults, but the results of surgery, especially on the syrinx, are better.
Specfically, their experience that"the results of the limited extradural decompression were poor" mirrors my own experience. Additionally,
J Neurosurg Pediatr. 2008 Jul;2(1):42-9. Links
Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis.
Department of Surgery (Pediatric Neurosurgery), Dartmouth Medical School, Hanover, NH, USA. srd@hitchcock.org
OBJECT: Surgery for Chiari malformation Type I (CM-I) is one of the most common neurosurgical procedures performed in children, although there is clearly no consensus among practitioners about which surgical method is preferred. The objective of this meta-analysis was to compare the outcome of posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) for the treatment of CM-I in children. METHODS: The authors searched Medline-Ovid, The Cochrane Library, and the conference proceedings of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons (2000-2007) for studies meeting the following inclusion criteria: 1) surgical treatment of CM-I; 2) surgical techniques of PFD and PFDD being reported in a single cohort; and 3) patient age < 18 years. RESULTS: Five retrospective and 2 prospective cohort studies involving a total of 582 patients met the criteria for inclusion in the meta-analysis. Of the 582 patients, 316 were treated with PFDD and 266 were treated with PFD alone. Patient age ranged from 6 months to 18 years. Patients undergoing PFDD had a significantly lower reoperation rate (2.1 vs 12.6%, risk ratio [RR] 0.23, 95% confidence interval [CI] 0.08-0.69) and a higher rate of cerebrospinal fluid-related complications (18.5 vs 1.8%, RR 7.64, 95% CI 2.53-23.09) than those undergoing PFD. No significant differences in either clinical improvement (78.6 vs 64.6%, RR 1.23, 95% CI 0.95-1.59) or syringomyelia decrease (87.0 vs 56.3%, RR 1.43, 95% CI 0.91-2.25) were noted between PFDD and PFD. CONCLUSIONS: Posterior fossa decompression with duraplasty is associated with a lower risk of reoperation than PFD but a greater risk for cerebrospinal fluid-related complications. There was no significant difference between the 2 operative techniques with respect to clinical improvement or decrease in syringomyelia.
Note that the comclusion of this paper is that "there was no significant difference between the 2 operative techniques with respect to clinical improvement of decrease in syringomyelia." I've mentioned this before at the site so I apologize for repition for some but, the definition of a statistically signficant difference in medical is usually identified as a p value, e.g. p<0.05, meaning that the chance that the data could just be random is <5%. But look at the raw data. Syringomyelia decrase was noted in 87% in whom intradural exploration occured, as opposed to 56% with an extradural operation. Symptoms improved in 79% of patients with intradural exploration, as opposed to 65% with an extradural operation.
Reverse those numbers and look at the failure rate. for a syrinx, the failure rate for surgery is 13% for an intradural operation and 44% without. the risk of failure is >3x higher(but the patient volume wasn't high enough to reach statistical significance).
What does that mean? Can anyone tell you will medical certainty that an intradural exploration is necessary for each Chiari decompression? No. In fact, it is unnecessary in most patients. BUT...if you don't go intradural(and we haven't been able to delineate who really needs an intradural exploration and who doesn't), the surgical failure rate will be higher, possibly >3x higher. The surgical risk is also lower with an extradural operation(if you don't go into CSF pathways, you don't run the risk of a CSF leak).
It has always been my opinion that I would prefer to deal with things that should be in my control(a CSF leak), rather than things I don't control(CSF dynamics in a patient who had an extradural operation).
I would suggest that most neurosurgeons with large Chiari practices have come to similar conclusions. I would love to have medical certainty with these decisions. That data does not exist.
My daughter (33 yrs) had decompression surgery x 2 (2010 & 11) for CM & SM. Since her last surgery two yrs ago, she has suffered nausea daily and has had very few days when she did not vommit as well. A recent MRI found a cyst in the area of the Medulla oblongata/4th ventricle. I found an article that attributed this type of cyst to the nausea/vommitting symptom. She now awaits a visit with a new NS. My heart goes out to you and your son. Hank
TracyZ said:
Toni,
Is your son on any medication or is he getting choked? Is it projectile vomiting or reflux? Have you gotten a second opinion? Sorry for all the questions. I just want to know how we can help your son.
Toni said:My son had his 1st decompression surgery w/ duraplasty and 8 most later he had to have a 2nd decompression w/ duraplasty. After the 2nd surgery, he had a VP shunt placed. The day after he had it placed, he puked and didn't stop for an entire year later until they took out the shunt. He puked less now but still often and random. His NS said this may be a life long side effect from the brain surgeries. I am trying to find out if vomiting has happened to anyone else and why? The NS gives no definitive answer for it. It is very frustrating..
Nausea is a common problem with posterior fossa issues. Clearly, you want to make sure the MRI is as normal as possible(no cyst, leak, etc). If not, medical management with GI is appropriate.
I had violent nausea that started in recovery and for 12 hours after my surgery, but I think I remember the neurosurgeon telling me that it was common with Chiari surgery. I had told the anesthesiologist before hand that I get violent nausea with anesthesia, but I'm not sure if she gave me anti-nausea medication or not. I know I was given 3 different types of anti-nausea medication after the surgery, but nothing helped. I haven't had any problems with nausea since then. In fact, the surgery seems to have cured my slow digestive system as I never have to take the medication to help with digestion anymore. I have a synthetic dura patch and I don't think I have problems with it. I am 16 months post op and still get fluid filled bumps (like pimples or ingrown hairs) all over my head and along my scar line. Sometimes they get large enough that they cause signficant pain. I never had that problem before surgery, so I'm not sure why I have it now or if it's even related to surgery or the patch.