What can I expect after surgery?
Cranioplasty with FMD appears to be well tolerated in dogs with CLM/SM with very few complications being noted. Most dogs are hospitalized for 4-5 days depending on their clinical condition. Because cerebellar decompression is immediate, intracranial clinical signs can be expected to resolve faster than those related to SM. The reduction in syrinx size is paramount to clinical recovery.
Syringomyelia is thought to be a slow progressive process and is a pathologic sequela of altered CSF flow dynamics, mechanical obstruction or both. The resolution of syringomyelia has been only recently reported in veterinary patients, and based on a large scale study, can take many months or even years to completely resolve. Because of this finding, dogs are frequently placed on tapering dose of predinisone, gabapentin, and tramadol to provide comfort until partial syrinx resolution is achieved. It should be noted that intermittent exacerbation of clinical signs is associated with excitement and should be avoided when possible.
Results of surgery and post-operative protocols can vary between surgeons and institutions for a variety of reasons. There are no guidelines that are universally accepted for this technique, nor is there a published optimum magnitude of decompression for human or veterinary patients. In human patients, excessive decompression can be detrimental due to cerebellar slouching and result in the need for revision surgery. Excessive decompression has not been recognized as a problem in veterinary patients and may be due to their natural horizontal position when compared with human counterparts, however, inadequate decompression may not restore normal CSF dynamics impeding syrinx resolution. Furthermore, the use of dural grafts to reconstruct the durotomy made during cerebellar decompression remains controversial. Although commonly performed in human patients controversy exists regarding which material is most suitable. In veterinary patients it has not been proven to be necessary and some believe it may contribute to scar tissue formation, surgical failure, and the need for revision surgery in the future. It is important for pet owners to ask their pet’s neurosurgeon about his or her specific experiences with this condition, how they handle different aspects of the technique, and what their expected results are so that they may make informed decisions.
Are recheck examinations required?
Because there is much to learn about this condition and the different treatment options available, follow up visits are an essential element to managing a patient successfully while generating the data to expand the knowledge base for all that will be treated in the future. Routine three to four week follow up appointments are typically valuable in assessing the general health of the patient, as well as healing of the surgical site. Since 60% of patients operated on at The Canine Chiari Institute at LIVS travel from out of state, evaluations done locally can be arranged for pet owners, as well as telephone consultations as needed. Many patients report dramatic improvements in the frequency or severity of clinical signs, which can be attributable to successful cerebellar decompression, early syrinx resolution, greater adherence to medical therapy protocols, or a combination of the aforementioned. Institutions involved in large scale studies, provide follow up whole body MRI evaluations at discounted or no cost, as a means of assessing CSF dynamics, degree of syrinx resolution, and for the development of other conditions that may result in clinical signs that imitate CLM. Beyond the follow up MRI, the management in most dogs involves minor adjustments in medications until the taper is complete usually within 5-6 months after surgery. In patients that travel significant distances for surgery, telephone consultations regarding medication adjustments typically suffice. Only 15% of patients required intermittent medication for life to maintain a normal quality of life.