Wiki Is a tonsillar reduction part of a chiari decompression?

Messages
12
Location
Greater Philadelphia
Best answers
0
ESTIMATED BLOOD LOSS:  20 mL.

TRANSFUSIONS:  None.

PROCEDURES PERFORMED:  Re-op intradural Chiari decompression with tonsillar reduction and duraplasty.

INDICATIONS FOR SURGERY:  who underwent an extradural Chiari decompression for headache in the past.  Her headaches immediately resolved and she has been doing great since the date of surgery.  She had had a very small syrinx which blossomed significantly with followup.  The risks, benefits, and alternatives of intradural exploration despite the possibility of bony regrowth were discussed with the patient's parents.  Informed signed consent was obtained.

PROCEDURE DESCRIPTION:  She was brought to the operating room, where general endotracheal anesthesia was induced.  Appropriate lines were placed.  She is placed in Mayfield head holder, flipped prone, appropriately padded and affixed to the bed in a chin-tuck position.  Neuromonitoring leads were placed and baseline signals were achieved.  She was prepped and draped in the usual sterile fashion.  A timeout was performed.

A 15 blade was used to make an incision through her old incision in the suboccipital area.  Dissection carried down to the bone, which had partially grown back over the cerebellar hemispheres and there was a complete foramen magnum had grown back.  This was dissected free with curettes.  Rongeurs were used to decompress the foramen magnum and widen the craniectomy back to its original size.  4-0 Nurolon and an 11 blade were used to make durotomies on either side over the cerebellar hemispheres and a Y-shaped durotomy was made with scissors.  The dura was tacked up.  The tonsils had been pushed widely to the side, and these were pulled up.  The tips of the tonsils appeared ischemic.  They were dissected free of the brainstem and the dura and bipolar cautery on low amplitude was used to shrink the tonsils up until they are above the foramen magnum.  The 4th ventricle could be appreciated, as was the choroid plexus and free flow of CSF was coming out of the fourth ventricle through the foramen magendie.  A bovine pericardium patch graft was cut to size and sewn in using running 4-0 Nurolon.  An EVD-style drain was left in the subfascial space, tunneled superiorly, and secured at the skin edge and connected to a sterile CSF collection system.

The wound was then irrigated copiously with Ancef irrigation, and closed in multilayer fashion with absorbable sutures.  She was flipped supine and extubated in the operating room in good neurologic condition and brought to the PICU.  There were no complications.  She tolerated the procedure well.

I, the attending neurosurgeon, was present for all critical portions of the case.  All counts were correct at the end of the case.  All neuromonitoring signals remained stable throughout the case.
 
Top