Decompression surgery technical/anatomy questions

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Hi, I would like to understand what exactly happens in the decompression surgery and have a few things I could not figure out from online sources. Maybe somebody in this forum knows about these:

1) when the craniectomy is done, where do the rectus capitis posterior muscles attach post-surgery - isnt' their attachment to skull pretty much where the bone will be taken away?

2) Can someone explain why C1 or even C2 bones should be cut, when the objective is to create more space _above_ the foramen magnum line for the cerebellum to fit?

Thanks if anyone can offer some explanations to this!

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8 Replies

  • Posted

    Hi Rosemar,

    1. If I am right I think to answer your no 1 question is by a pointed tendon from the spinous process of the axis, and, becoming broader as it ascends, is inserted into the lateral part of the inferior nuchal line of the occipital bone and the surface of the bone immediately below the line. , but check with your doctor wen you make appointment next.

    2. The rational of cutting the C1 or C2 is to give more room therefore its lift the pressure and provide normal flow for it. Again go and ask your neurologist if you are not sure.

    Your should have fire all that questions to your health care professionals on your visit, such an important condition and also getting explanation from your expert would give you peace of mind, when yo next seeing them, write it down what you are worrying or have questions about...but if you have not have dec ompression, in my opinion DO IT..as soon as you can..DONT delay it

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    • Posted

      Hi b2wc97455, and thanks for the reply - yes I will ask the neurosurgeon for sure, just thought someone here might have already asked the same questions. As to question 1, I am not very familiar with all the anatomy terminology, but do you mean those muscles will be attached to a different location on the skull bone? 

      When I look at surgery videos, I don't see the muscles being detached or cut in the first place, but looking at separate anatomy pictures, looks like they would be on the way of the craniectomy. 

      As for the 2nd question, yes I suppose room is needed both for the bralnstem/tonsils as well as the spinal flow, so I guess you are right. Or maybe the extra room at c1c2 level is needed for the tonsils to start their migration back up, so nothing holds them there...? it will take time, eg right after surgery MRIs don't show much improvement of the tonsils, yet many people have their symptoms immediately relieved, maybe for that extra space around c1?

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    • Posted

      Dear Rosemar,

      Each surgeon perform different method, mine did not attached to anything, as he did not even put dura in it neither, hence I do not have any other symptom after surgery....on the other hand just imagine your feet is size 6 but your shoes is size 5..so any surgeon have to enlarge a little of the shoes to make your feet feel comformtable..hhhmmmmmmm (does it make sense???)..when are you seeing health care professional again..?

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    • Posted

      Dear b2wc97455, 

      Yes thanks the shoe thing makes sense, but my question was kind of to understand that if your shoe is too narrow in the front and you need more space for the toes, why would you also widen it at the heel? wink so the space is tight above foramen magnum, limited by the back of skull, then why would you need to make space at c1 level, which is below the foramen magnum. But maybe to make space for the cerebral fluid flow, that would make sense. Will see the surgeon soon so can ask if I have time. Surely I don't need to understand every stitch and every choice to the detail and trust the surgeon, but this thing just made me wonder why it's done.

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    • Posted

      Well each individual are different, its depending how the herniation lays-out..some need only the C1 to be sorted it out some need C2, some need both, some need shunt..so..its very difficult difficult to see unless they see your cine/mri and your condition - have you got lots of symptom, just to remind you, its only getting worse, chiari is not disease, its defect..so any defect in human body can only be altered by surgery...just think about a car if the the carburetor is damaged that need to be changed or repair otherwise the motor will not start either...but do not worry too much about nitty gritty of the anatomy ..just get sort it as soon as possible..the longer you leave it worrying of the risk of surgery etc..the worse you are going to get...
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  • Posted

    Hello Rosemar,

    Do you have a surgery soon? What kind of symptoms do you have? Started they progressive? Do you have also let your csf checked with a cine mri? Do you have a syrinx? A couple questions from me instead of answers for your questions ;p. But that bone cut of c1/c2 is with each person different.

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    • Posted

      Hi cakal76334,

      Yes the surgery will be within a couple of months, no syrinx but worsening other symptoms, headaches the main thing. Yes our doc had the cine flow done.

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