Chiari malformation treatment with cerebellum tonsillectomy

The tonsils of the cerebellum act like a cork that is tightly pressed into the upper spinal canal, causing compression. In some cases, removing these tonsils (cerebellum tonsillectomy) can eliminate this compression and improve the flow of cerebrospinal fluid. Therefore, the procedure is sometimes used for Chiari malformation treatment in selected patients. Before the procedure begins, the patient is given general anesthesia and positioned on his stomach. His head is securely held in place with a rigid bracket. The size of the skull opening differs depending on the patient's age. However, it should align with the maximum width of the cerebellum's tonsils. Once this is done, a cervical laminectomy is performed, which should extend up to the top of the cerebellum's tonsils. Usually, this can be achieved by resectioning the posterior arch of the first and second cervical vertebrae. The surgeon uses special scissors to make a Y-shaped incision in the dura mater, then removes the cerebellum's tonsils using an ultrasonic scalpel. The extent of the tonsil removal depends on how much they have changed. Next, the wound is closed using non-absorbable suture material, and the skin is sewn up with a cosmetic intradermal suture. Finally, an aseptic bandage is applied to the operation area.