The only effective treatment for Chiari malformation is surgery. The most common surgical procedure is suboccipital craniectomy to decompress the cerebellar tonsils (surgical opening of the bony compartment of the back of the head) with laminectomy of C1 and/or C2 to decompress the cervical spinal cord. Opening of the dura (lining of the brain and spinal cord) with dural grafting to expand the cranial and upper cervical spine space completes the procedure. Sometimes the surgeon will elect to not open the dura. The procedure is performed under general anesthesia and usually lasts two to three hours.
The recovery period requires a one-to-two-day stay in the intensive care unit for neurologic observation. This is followed by another one-to-three days in a general hospital room to complete hospital recovery and resume independent self-care activities. The total hospital stay averages three to five days. The postop pain is moderate and may be associated with nausea for the first 24-48 hours. These symptoms are effectively controlled by medications administered by the nursing staff.
Outpatient recovery usually takes four to six weeks. During the first two weeks, no driving is allowed. A return to an office job or sedentary work can resume approximately four to six weeks after surgery. Full physical activity can be resumed in approximately two to three months.