Frequently Asked Questions

What Happens When I go Into Hospital for My Craniovertebral Decompression?

How long will I be in hospital for?

This varies from one individual to another, there are no hard and fast rules. The total length of time somebody spends in hospital depends upon various factors including that individual's age, what facilities they have at home when they are discharged and whether any complications occur. Most people stay in hospital for about a week after the operation, sometimes longer, perhaps two weeks. This assumes there are no complications. Obviously the spell in hospital may be a good deal longer if complications develop.

How long will in need to take off work/college?

Craniovertebral decompression is a major operation for anybody to undergo. The body needs time to recover. It will take at least a month for an individual to feel anywhere near normal again. It is advisable for anybody to assume they will be off work for at least six weeks, perhaps as much as three months. To some extent the period off work is determined by how essential it is for somebody to get back to their employment. Professional people, self-employed and highly motivated individuals tend to get back to work sooner but unless there are pressing need it is best for somebody to recover adequately first.

How long will I be in the operating theatre for?

The operating time from "skin-to-skin" would be about two hours on average but the period will vary according to the state of the anatomy of an individual case. There is, however, a good deal of preparation to be made, both before and after someone is anaesthetised, before the operation as such begins. After the procedure, when the anaesthetic is reversed, there is a period to be spent in the recovery bay, before a patient returns to the ward. All in all it is likely that you will be in the theatre suite for the best part of a half day.

What size wound will I have and what stitches will I have?

The wound is about four inches long, in the midline at the back of the head/upper part of the neck. Quite a few stitches need to placed deep to the skin, in the muscles and other layers. These will absorb over time. The skin is usually closed with non-absorbable stitches or metallic clips, which need to be removed. Usually after about ten days.

How much hair will I lose underneath this?

Some surgeons choose not to remove hair but most will take off a strip of hair in the midline, at the back of the head. Most surgeons are more comfortable doing this, feeling that the skin can be better cleansed and the risk of infection minimized, although this is not something that can be proven. The head shave also allows for a wound dressing to be applied more readily.

What follow up will I receive?

In most cases an outpatient review appointment will be arranged in due course. Ideally this will be six to eight weeks after the surgery but it may be longer, depending on the pressures of local clinic appointments. If problems arose in the meantime your family doctor would be able to request an earlier review, by one of the neurosurgical team.

Will my headaches improve?

Cranivertebral decompression aims to correct an internal anatomical abnormality. Many of the symptoms that arise as a result of this abnormality may well improve after surgery. Headache, the commonest symptom, is the one that usually responds best. Even if headaches do not resolve completely, they usually improve significantly. Indeed, craniovertebral decompression can be a life transforming operation. Sometimes headaches may return after an interval but they are not usually as severe as they were prior to the surgery. There are a variety of possible causes of recurrent headaches, as well recurrence or persistence of other symptoms. You would need to discuss these matters with your surgeon.

Will I be able to fly?

This is commonly asked question, one posed by people undergoing intracranial surgery of any type, not just craniovertebral decompression. Problems might arise when there is air inside the head, which occurs after intracranial surgery, particularly craniovertebral decompression and especially when this is carried out in the sitting position. If somebody was carried on a high altitude, long haul flight within a short time after such an operation difficulties might arise. By a month after surgery any air in the head will be absorbed. It is unlikely in any case that someone would choose to take a flight within such a short time after major brain surgery.

Will I be able to drive?

In the UK the Driver and Vehicle Licensing Authority place restrictions upon driving following some types of intracranial surgery. Posterior fossa surgery - craniovertebral decompression falls into this category - does not generally require a set period off driving, beyond the need for the individual to have recovered, in general terms, from the surgery. You should not, therefore, plan to drive yourself home from hospital a week after the procedure! It is probably best that you find a "chauffeur" for the first month or so after the operation.

When can I wash my hair?

There are no strict rules here. Most surgical departments will try to avoid hair washes until the stitches are removed. Even when the stitches do come out the wound is not fully healed by any means so you should take care when washing your hair. Gentle rinsing rather than vigorous rubbing would be appropriate.

What happens if I have problems in the future?

You should consult your family doctor. He or she will almost certainly refer you back to your neurosurgeon who will see you in the clinic and matters can be taken from there.

What is the total recovery period?

Even though skin stitches are removed early on, there is long way to go, both in terms of wound healing and recovery from the surgical trauma. Nature's healing process cannot be rushed. It will be at least a month before you feel human again. By three months after the surgery you should have resumed most normal activities. It will be six months, however, before you can push yourself to any degree, e.g. vigorous sporting activity. As regards recovery of lost neurological function this will vary from one individual to another, there may indeed be no recovery of neurological function. The principle aim of the surgery is usually defined as preventing further deterioration, particularly if it is for syringomyelia associated with hind brain hernia. Recovery of lost function may be seen as a welcome bonus. As a general rule of thumb it may take up to two years for recovery of any lost neurological function. Beyond that period it is unlikely that further improvement will occur.

Will my hind brain hernia ever return?

A chiari malformation is a true hernia in the sense that one body part, in this case the tonsils of the cerebellum, protrude through an opening, in this case the foramen magnum at the base of the skull. A much more common hernia, of course, is one in the abdominal wall or the groin. These can certainly recur, if a surgical repair fails. Craniovertebral decompression is somewhat different from repair of the abdominal wall. At the craniovertebral junction we are trying to create room for the herniated cerebellar tonsils and to allow CSF to flow across the craniovertebral junction. We are not trying to repair a weak container. All surgeons will, therefore, try to open up the CSF channels at the craniovertebral junction. Most will open the membranes that enclose the CSF. Some will apply heat to the cerebellar tonsils, to shrink them in volume. Some surgeons will apply a patch to the membranes that they have opened but others will not. Problems can sometimes arise later on if scar tissue forms at the operation site. This may then cause the surgically created channels for CSF flow to close down once more, obstructing CSF movement again. This is not a recurrence of the hind brain hernia as such but it can certainly lead to recurrence of symptoms. Furthermore, it can be very difficult to treat because revisional surgery at the craniovertebral junction is hazardous, the anatomy being distorted, by post operative scar tissue.

Where will I have the surgery?

Craniovertebral decompression is major brain surgery. It needs to be carried out in specialist neurosurgical units. Most major cities in the UK have neurosurgical units but we do not have neurosurgical facilities in all district general hospitals. There are 35 units in the UK, including specialist children's units.

Prepared for The Ann Conroy Trust by Consultant Neurosurgeon Graham Flint and Karen Thacker and peer reviewed by members of The British Syringomyelia Interest Group

2008