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On 11 Aug 2002 at 11:28, Deborah Setzer wrote: > put some more detailed info on this disorder online World Arnold Chiari Malformation Association Q&A Session with a Surgeon By Scott Chadbourne: The following question and answer session between a chiari patient and his neurosurgeon is not only a great list of questions that you too can ask, but it is an excellent source of information for Chiari Patients in general. Is ACM (Chiari syndrome) a congenital disease? A)Many indications allude to this, but it is not medically proven as yet. But it will be. Do you think my symptoms of headaches, fatigue and depression could be associated with this condition? A)Without a doubt. Does the length of time between onset of symptoms and surgery impact recovery? A) Maybe. At first we thought that this was the case, but many people have great recoveries after years of symptoms. Why some get better and some don’t we aren’t sure, but you can get better. Is this why I may not recover from fatigue and depression, due to time of compression without treatment? A) Maybe. (See above answer) Do many patients with “Chiari syndrome” suffer with changing pains, complaints and symptoms? Why? A) Yes, it is a classic sign. It’s because of the areas compressed by the condition in the main nerve centers of your brain/body. The pressure of the CFS affects these areas different due to many reasons. Is this condition often mis-diagnosed? Why? A) It’s is considered rare by most NSG’s and they just don’t know as much as a few of us who have had experience with it do. Is there any way that this condition was not present 3 years ago? If so how? A) The condition as seen on the MRI’s was there. An accident could begin the onset of symptoms, but in your situation that doesn’t appear to be the case. Is it unusual for the symptoms of this disease to come on suddenly in mid-adulthood? Why? A) No, it often comes in mid-life. My best guess why is just accumulated wear and tear on the compressed area. Is this a degenerative disease? A)Yes. It may plateau for years at a certain level, but will usually resume. How many decompression surgeries have you performed? Describe your successes and your apprehensions. A) Well over 100. I did 5 last month. The successes are what we hope for in every patient, a complete recovery. But as I stated not everyone gets all the way better. We just do not know why. Will I need blood? Should I provide my own in advance? A) No. And no. Am I at a greater risk of injury ( a fall, auto accident, ect) with or without surgery? A) No. The risk of damage in an accident with elevated CFS pressure is greater than after being decompressed. Is a laminectomy of C-1 and or C-2 always necessary and does it cause some structural instability? What about long term structural effects? A) C-1 almost all always, C-2 only if the herniation dictates. Very little of the bone is removed in this procedure and although it could happen I have not seen any long term instability. Do you plug the obex? A) No. Do you always open the dura? Why? If yes, does this increase the chance of scarring and problems later? A) Not always. It is a decision I make after getting in, decompressing, and then evaluating if I think it is necessary. I lean towards opening if there is any question as to the room available for CFS flow. Do you “shrink” the tonsils? What is this ? A) No. Usually this consists of removal. Dr. Milhorat has a technique in which he removes a large portion of the Occipital bone and does not open the dura or cut down C-1 or C-2. What do you know about this procedure and is it extreme? A) Dr. Milhorat is very good. His technique is not extreme, just a different approach. We also seem to get very different patients. I seem to see people with very small cervical canals and he seems to get people with large herniations or persons who have not had success with a traditional decompression. Do you think his procedure would lend itself to “cerebellar slumping”? Will this happen anyway? A) No, I do not think so. I have not seen much slumping, and I do all I can to prevent it while I’m in there. Have you used any patient supplied periosteum (scalp) or pericardium grafts instead of bovine? A) I used to. I have the best luck with processed human pericardium and bovine. I have the worst trouble with frozen human pericardium. What are the rejection rates for each? A) I do not see much rejection. What many people (NSG’s even) see as rejection is often just a bit of foreign material that gets into the spinal fluid, like a drop of blood. It causes a case of Aseptic Meningitis and we deal with that accordingly. (Steroids usually) Does a poor graft cause hydrocephalus? What % get it? A) No. Less than 10% Can you harvest material from the patient to perform the dura graft with to prevent rejection and/or scarring problems? A) I could but I don’t. (See above question) I have not seen any difference in the scarring of one graft material over the other. How often do you discover a syrinx while performing the surgery that was undiagnosed before? A) Very rare. We usually find them on the films. How many develop a syrinx after decompression surgery? A) Not many, unless the compression returns for whatever reason. What percentage have leaks in CFS and how long after surgery can they show up? A) I don’t seem to have too many leaks. I can remember 4 or 5 that I had to go back in and repair. (Out of 100+) Usually if it isn’t leaking in 2-3 days, it isn’t going to. How are neurological functions monitored during surgery. Do they include superficial and deep reflexes as well as cranial nerve function? A) I use evoked potential and (something else I missed) throughout the surgery. Do you “rack” your own patients? If not who does? Any complications? A) I do it myself. I have had no problems yet. I also place my patients in the prone position during surgery as I feel it is safer. How often do you suggest follow-up MRI’s post-op? Follow-up-with you? A) No MRI follow-ups unless you are having problems. I like to see my patients at 4 months, 8 months, and one year. Do you recommend PT post-op? A) No. I used to but most Pt’s don’t know what a decompression surgery patients need. I have a couple of exercises I recommend. How many days are usually required in the hospital before release? A) 2-5 Usually if a patient is not ready to go home after 3 days, there is a reason (ie fear, spouse, kids) and they just want the rest. Do you recommend to fly or drive home post-op? Can plane pressure cause a problem with CFS leaks? A) It’ doesn’t matter to me. I have patients do both, even long distance. No leaks caused by flying that I know of. Will my Medicare Insurance be sufficient or should I wait until I have more coverage? A) Yes, lets do it. Are there rooms available at the hospital for family? A) No http://www.pressenter.com/~wacma/morquest.htm * * * ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn