Is it normal for a concavity / depression / dent to form where the bone was removed?

[Lidiaggl]

I had my decompression surgery about two months ago, and I have been noticing that there is a noticeable indent where the bone reduction was done.  I have been thinking it was getting deeper, and today my PT agreed.  Overall, I feel better than before the surgery, and my recovery is going about like I was told to expect.  However, I am still having some sharp pains and headaches centered right where the 'hole' is, and like some other people have posted, I can't lay down with the back of my head on a pillow.  I read the following post on here from 2011, which did not get an answer - it is similar to my situation:

"strawberry22 - Hi.. I am about 9 months post op.  I woke up last night with this intense pain right where the incision is.  It is usually sunk in pretty good.  But my husband and I feel it is even more sunk in.  In know this sounds weird.  But we are wondering if it us something to worry about or not? - Jun 26, 2011"

Like strawberry22, I am wondering if this is normal.  It was not mentioned by my doctor, and I don't find any other references to it on this forum or others.

[selmaS]

  Really? hmmm most have a MRI post op...mine was at 1 yr post op but I had several post op visits...one at 6 weeks then 6 months and then 1 yr....

It is pretty much routine where I went with the post op visits....except if you are having issues they see you more and do a MRI sooner.

Stress can trigger a flare of symptoms especially this soon post op....how is your daughter, is she ok?

[Lidiaggl]

I was surprised another MRI wasn't wanted, but I live 4 hours from where the surgeon is, so cutting down on follow-up visits is a good thing.  They told me another MRI would only be advised if there are complications.  Stress could sure be an issue, the way things have been lately.

My DD managed to flip her boyfriend's dirt-bike going off the road (yes...) about 30-40 MPH when she hit the ditch because she panicked and missed the brake pedal.  She got thrown about 20 feet after her head, then her hips hit the handlebars.  She broke my husband's brand new helmet, and after the paramedics got her to the ER on a back-board with a cervical brace and splints, and they had to cut her new jeans and everything else but her socks off her (I mean, why not cut the socks off, too, just to make it complete?), she had no broken bones, no internal injuries, and no abrasions.  She is moving better today and is out of bed.  The worst looking part is the rope burn from the helmet strap - it looks like someone tried to hang her.  The ER doctor said she possibly sprained her pelvis.  Still it's a good thing we're fearless and teenagers at the same time: Someone older would have broken 20 bones.

I'm hoping to hear from the NS's office in the morning.  I am having some really weird feelings and not thinking quite right also.  I keep getting this burning in my nose like when you get pool water in your nose.  Also having heartburn along with crawly skin, tingling, and aches only on my right side.  I do not want to go through the weekend feeling like this.

[selmaS]

  WOW !! I was in ICU for 2.5 days I can not imagine going home that soon.

So your Dr did  not rule out the typical related conditions b4 you had surgery?
That is surprising and then again it's not really.....it seems there are many that do this surgery that do not rule out related conditions and it can be the related conditions that can cause some of the continued symptoms.

When are  your scheduled for another follow up? A MRI ?

[Lidiaggl]

As CM procedures go, mine was pretty minimal, though certainly uncomfortable enough!  No duraplasty, which I'm told is the big difference.  I can't say that other issues weren't considered and ruled out.  I was seen by several doctors as my major symptoms worsened very rapidly.  About two hours passed between the completion of my first MRI and my primary doctor calling me with the CM diagnosis.  

I was lucky to get my referral accepted by the Swedish Hospital Neuroscience Institute in Seattle.  Dr. Delashaw is very familiar with CM corrections, and he went over a whole series of imaging before my initial conference.  He's so confident and direct that it would be almost awkward to ask if he considered these related issues.  --- almost.  I'm going to ask as soon as I get the reply to yesterday's questions.

I was told that the procedure I had was unlikely to solve every symptom I had, and that there were some symptoms that would probably be unchanged.  I can say that most of the really 'impossible' issues are either improved or much less frequent.  Wednesday was pretty rough, but I had a pretty active session of PT Tuesday, so maybe that stirred things up.  Or maybe it was my DD's motorcycle crash on Monday, the 4 hours of ER, and taking care of her since.  This is the most active I've been since the surgery.

My post-op was April 18, and my final follow-up was May 9.  At that point, they were very happy with my progress and saw no reason for additional imaging.  No MRI is planned, and unless things go really wrong, they don't plan to see me again.  My suture has healed so well the PT says he can't believe it's only two months old.  The line is almost invisible.  Every doctor that has seen it has been impressed with Dr. Delashaw's sewing.  Anyway, from here on out I just follow up with my Primary.

If it wasn't for the strange indent and the continued sharp pains and dull headaches from that same spot, I wouldn't even still be reading up.

[Lidiaggl]

This is what we were told by the nurse today.  We never knew she had small dural tear.
The complete name of your surgery was a suboccipital craniotomy with a cervical 1 laminectomy for decompression of the chiari malformation, closure of small dural tear with sutures.

In talking with the doctors - the indent that you feel is likely scarring.

I don't believe that any imaging was performed during your surgery unfortunately.

Are the pains constant or are they intermittent?

[selmaS]

  Hi Lidiaggl and welcome to the Chiari forum.

The indent is typical and can worsen if you are not doing exercises to help those muscles keep from getting too tight  or allow scar tissue to form.

Have you been doing neck exercises? Since going to PT I expect you are.....do you have a copy of your OR report? What all was done during your surgery....a laminectomy, but did you also have a dura plasty?

And are you aware of any other related conditions to Chiari you may have?

[Lidiaggl]

I have been doing the neck exercises since the day of the surgery.  They told me that as soon as I could walk, I could go home, so I got up and walked!  One aspect of the anesthesia on me was it made me claustrophobic.  I could not stand having the pressure leggings on.  So they required me to be walking from day 1, and I was discharged the day after my procedure.

Your questions about what exactly my surgery was reminded me that I don't know, exactly.  I sent a message (just now) to Dr. Delashaw's office to get a more detailed answer.  Originally, they had said it would be a reduction of the occipital bone, and possibly a laminectomy.  At one point, the PA told me I did get the laminectomy, but later I was told I didn't.  Nobody has told me that there was any duraplasty done.  I had Type 1 CM with 6mm herniation of the tonsils.

If I have any related conditions, I am not aware of it. As I read the profiles on this site, it does make me wonder, since I have been treated without a lot of success for many of the symptoms others are describing.  My CM and the related symptoms might explain much more than just what got me diagnosed.