Minimally invasive surgery question ...Ask the Doctors

[Guest guest]

Hi guys... I wanted to share another " Dr. Answer " to our question regarding

minimally invasive surgery.

My thanks again go to Dr. Hess for taking the time to answer this for us.

By way if introduction:

D. Heiss, MD is a staff neurosurgeon at the National Institutes of Health

in Bethesda, land. He conducts clinical research protocols that examine the

pathophysiology of syringomyelia and the genetics of Chiari I malformation. As

Vice-Chair of the NINDS Institutional Review Board and Chairman of the Surgical

Administrative Committee . . . http://www.asap.org/announcements.html

Sally R... Decompression '91, Hydro, VP shunt, 2 shunt revisions, Feeling pretty

good on NO meds in Bethlehem,Pa

Sally:

If minimally invasive decompressive surgery for treatment of Chiari I can

relieve the obstruction in the CSF pathways as well as conventional surgery can,

then minimally invasive surgery may be preferable to conventional surgery if

other considerations such as duration of surgery and complication rate are

similar in either treatment. The minimally-invasive part of the surgery allows

a shorter skin incision but the extent of bone removal should be the same in

either procedure. Minimally-invasive surgery for Chiari I is now being

performed at several medical centers but I have not seen any studies comparing

the long-term results of standard surgery and minimally-invasive surgery.

Long-term results are important because Chiari I and syringomyelia can progress

slowly and long-term follow-up with MRI and neurological examination is

necessary to detect if treatment has been successful in resolving the syrinx.

During the present period in which there is little information on the long-term

results of minimally-invasive treatment some patients will be interested in

being treated at centers offering minimally-invasive decompressive surgery for

Chiari I and syringomyelia. If these centers carefully analyze the outcome of

minimally-invasive treatment with respect to resolution of the syrinx, pain,

weakness, sensory loss, etc. and compare their results with standard treatment,

it will provide later patients with pertinent information about the advantages

and disadvantages of minimally-invasive treatment versus standard treatment.

Please remember that syringomyelia is caused by tissue that obstructs the CSF

pathways. In the case of syringomyelia associated with Chiari I malformation,

the cerebellar tonsils obstruct the CSF pathways. In other types of

syringomyelia, the obstruction is usually caused by scar tissue that remains

after inflammation or trauma. Surgery that opens the CSF pathways is the most

reliable way to permanently relieve syringomyelia, and the primary surgical

objective is therefore to effectively remove the obstruction. I recommend

surgical procedures that effectively open CSF pathways.

Best regards,

Heiss, M.D.

D. Heiss, M.D.

Staff Neurosurgeon

Surgical Neurology Branch, NINDS

10 Center Drive, 10-5D37, MSC-1414

Bethesda, MD 20892-1414