Post-op Nausea with Dural Scoring?

[heather704]

Hi all -
I'm new to this forum, and considering decompression surgery for a 13mm herniation, which has caused headaches, neck and shoulder pain since age 13 (I'm 35 now).  My surgeon recommends scoring the dura (versus a dural patch or graft).  I've spoken with 4 patients who have undergone decompression surgery; all had a dural graft, and all had nausea and vomting for up to a week post-op.  The surgeon is telling me nausea and vomiting are not usually a problem with the dural graft, as the dura is not fully penetrated, drastically reducing the risk of blood in the spinal fluid or CSF leaks.  Has anyone had this procure with the dural scoring, and did you experience nausea and vomiting post-op?  If so, how long did your symptoms persist?
Thank you!  

[selmaS]

I agree, it is a drs option to do one or the other, and which they prefer, but I also feel what is needed for the patient can also affect that decision.

Thanks for the link, it is very helpful to learn about other procedures, I have heard this one b4, and was told it was less invasive and used for situations that did not warrant a full decompression...so I read into it a bit : )

And like Carolyn said avoid all the scary stories and focus on facts....yes there r risks....but not having the surgery poses risks as well.

AS long as u have a dr u r comfortable with and u feel it is time,....it all falls into place...u will still be nervous, but that is normal.

"selma"

[*Stormy*]

Some advice...try not to read the horror stories!! They will just scare you and those circumstances are VERY rare!! For my experience, I did have some pain issues due to allergic reaction to meds....but I made it through and having surgery was the best decision I ever made. So try to take it easy :) I know it's scary..but when you get your date, just try to busy yourself so that you don't think about it too much. Mine was right after Christmas so it really kept my mind off things.

Take carexx
Carolyn

[heather704]

Thank you so much everybody!  I read so many horror stories last night (one girl even mentioned being on a feeding tube 1 year post-op), that I was absolutely scared to death.  I have had anesthesia before, and did not have nausea or vomitting, but - as I said - the four patients I have spoken with in person who had the procedure were very sick for quite some time after the surgery.  

Selma - I have been lead to believe that the decision to open the dura or not is largely dependent upon the surgeon's "procedure of choice".  As Jim mentioned, my surgeon does use ultrasound to guage the effectiveness of dural scoring, and sometimes does opt to do a dural graft, particularly if scar tissue is present, or if the patient requires a second surgery.

[BigJim_in_NY]

I think you got it perfectly : ).

Other people may need the patch but I am not sure how you would tell pre-surgery or if there even is a qualification for one procedure over the other. I also have no idea how much extra room the patch gives? Maybe a millimeter?

What I have often read in the literature is the use of a special ultrasound to measure CSF flow while you are being operated on. No one has ever said to me this device was used during their surgery and I don't know if it was used during mine but I assume the Dura could first be scored and if the NS then felt flow wasn't sufficient he or she could then proceed with a patch...

There are posts from people on the internet that have had revisions with a patch where none existed prior but I don't think a conclusion can be drawn that it was the lack of a patch from the first surgery that caused a failure.

[*Stormy*]

Welcome!

I think for most of us the issue on whether you vomit or not really has do with how you react to the anesthesia and the meds they give you afterwards. I had the actual duraplasty (where they open the dura and patch it) and I had a little nausea but no vomiting. Most of the members on here feel that if they had it, that it came from the meds. Of course, if you have a leak you will feel sick, but that's a complication of the surgery and fairly rare (with dural scoring I don't even know if that's an issue since they aren't actually opening it). So, in my opinion, your chances of vomiting are about the same as if you had any other surgery that causes you to be put under general anesthesia. If you are really concerned, I remember one member here that insisted on anti-nauseants for b4 and after surgery and she swore by it, she recovered quickly and never felt sick at all.

Good luck
Carolyn

[selmaS]

Heather and Jim...u r making some sense here.....and I am sure tho, that there r some of us that need the NS to get in behind the dura area to "work" back there, so it will depend if u qualify for that type....or do I have this all wrong?

[BigJim_in_NY]

I had the surgery without the patch and didn't vomit once but I too doubt that the type of surgery leads to more vomiting.

Dural patching is now a subject of debate. The reason I picked the surgeon I did was because he was aware of this newer method of Dural Scoring and the procedure to include outcomes and reduced risks made sense to me.

I guess the best example to relate to dural scoring would be like loosening your belt a notch so your pants aren't so tight around your waist. It has been shown in those with Chiari that ossification of the Dural Band can occur and it isn't as flexible as it should be. Snipping that band lets your brain "out" so to speak.

[heather704]

Hi Selma,
Thanks for the reply.  There is increasing evidence that decompression surgery is just as successful without opening the dura, and dural scoring greatly reduces the risks.

There is a good article here, if you are interested:
http://www.conquerchiari.org/subs%20only/2010/Jun/Duraplasty%20vs%20No%20Duraplasty%206-10.asp

[selmaS]

Hi and welcome to the Chiari forum.

I had a dura patch and only had vomiting while in ICU from the morphine, once my meds were changed I didn't have ne more issues with it.

I really do not feel one procedure over the other is really going to affect vomiting  more than the other....like I said for me it was meds that caused the issue.

I know some that had leaks too, and nausea was a result of that....u want to be sure u have a true chiari dr b4 making this decision.

I do not understand how dura scoring helps as it  does not allow the dr to get in where the overcrowding is to correct it.

Please look into getting a second opinion just to see what options are available.

We r happy to have u join our little family here, but not happy for the reason u had to seek us out.

"selma"