Chiari: Cut the dura or not?

[happy1975]

Hello! I have recently been diagnosed with an 8 mm herniation /chiari.  My question is after seeing 2 neurosurgeons that have opposing views on the type of procedure they perform during surgery, which is recommended?

The first neurosurgeon recommended absolutely not cutting the dura to avoid complications and involving c1-c2 during surgery.  
The second said absolutely they will go through the dura to relieve more pressure and ensure another surgery isn't needed and being very adamant that they will only work on C1 and not to involve C2.  

Anyone have experience making the decision between the two different techniques?
Thanks!!!  

[Elisaandbucky]

Hello again. Your anxiety over when you will be able to shower is certainly something I can identify with. Showering is so much more than physically cleaning yourself. For me, it can really be essential in renewal - especially when you must deal with the inevitable pain after surgery. I have a hand held detachable shower head, so I could at least wash below where my incision was. I also noticed that you are not sure about having any additional time to consult with your doctor before your surgery. Best thing to do is to keep in touch with Mel. She may be able to answer many of your questions to make you feel more informed about the procedure and what to expect after in recovery. I wish you well.

[Mel5056]

HI there,


Feel free to send me a message and i can go over everything with you.  There are pros and cons to surgery with her.    I believe it's a Bovine patch that she uses but can only confirm what she did with me.  I do suggest you rule out everything first before that surgery.   Again message me and i can go into detail about it.  

Mel

[Rhinda]

Having surgery with Dr. Gilmer  in the near future.  I was just diagnosed this week after 8 years. I would be interested in your general impressions.  I came away from my appointment with many questions, and there is no additional appointment scheduled before surgery that I was made aware of.  Will there be a consultation before surgery?  How do you feel about what she did with your tonsils and also what kind of patch does she do?  Do you know anything about how may decompressions she has done?  I felt good about my visit with her.  I just didn't get much time to ask questions as they were behind.  Thank you!

[selmaS]

  Everyone and every Dr is different as to what is best for that person.....for me since I have EDS they harvested tissue from my scalp.....this was to help reduce the risk of rejection which could cause a CSF leak or inflammation....

I had no ill effects ...no leak or other issues....

Make sure you do not have EDS b4 surgery to help determine which patch is right for you.

[happy1975]

What is recommended to use as a dural patch? I read about cadavers, etc. but wondering what people recommend ?

[happy1975]

Wow! Nice to know someone who has had her surgery!  Would you mind explaining your experience ? I think my anxiety will be less if I know the way it works at Beaumont... when you get admitted what are the next steps? How long did you stay? What was it like waking up?
Funny as I am nervous about how long until I will be able to take a shower after the surgery! lol  
Were you happy with her follow up care?
How long until you could drive?
What is the best way to prepare?  When you came home did you sleep in a recliner or a bed?
Thanks in advance...  

[Mel5056]

Hi,  i had surgery with dr gilmer july 7.  Dr g also resects the tonsils so you know.  There is a lot of discussions around that as well. Its a very hard decison to make as i debated back and forth as well.  I chose to go with dr g praying i only need to do it once.  I am 43 and had never had one surgery ever.  I am only 6 months so still way too soon to tell where i end up.  I do cation that when they say it takes 12-24 months to recover its the truth.  You will have good days and weeks but you will also have some bad.  Anyway if you have any questionsi would be happy to assist.

[selmaS]

  I am familiar with her name as other members have been to her.....

You did not mention what type of patch you will be getting....I guess you will find that as well as ruling our ALL related conditions at your next appointment.

  Good luck and keep us posted...and use the  list your surgery date to have a prayer thread posted for you.

[happy1975]

Great questions to ask ! I have an appointment in 3 weeks , then surgery with dr holly gilmer In March.  Anyone heard of her? At Beaumont hospital in Michigan ... She will be opening the dura and removing c1. Thanks for info!

[selmaS]

   Hi  and  welcome  to  the  Chiari forum,

The  procedure  that includes  not  opening  the during,does  require  a follow  up  redo with the dura  finally  being  opened  as the benefits  are  short  lived....this procedure  was  done  on small children  to make  the procedure  less  invasive....

  I  also  feel it is a  NS  that  is  not well  experienced  doing  the decompression  and  is  worried  about  a  CSF  leak.

  Did  both  Drs  rule  out  ALL  related  conditions?Syringomyelia,POTS, ICP,Sleep apnea,tethered cord, Ehlers-Danlos?

  The  one  that wants  to open  the dura , what  will  they  use  as  a dura  patch?

  

[Elisaandbucky]

I also have heard and read about this disagreement among surgeons about whether or not to open the dura. My dura was opened and I had the laminectomy of c1 and c2. It seems like the reason to open the dura makes most sense, so another decompression is not needed soon after. However, I am not a doctor. I can just tell you that my recovery (5 months post-op) is going pretty well with only occasional days of pain. My big thing is sleep - I can't get enough!