Prior to the day of surgery you will meet with Dr. Osterdock to review the plans for surgery as well as the MRI scans and any other test results. You will have the opportunity to ask any questions that you have. Sometimes it is helpful to come with a list of questions that you have had regarding surgery so that the important ones are not forgotten.
Typically, after this appointment you will be sent over to the lab to have blood work done which is essential for surgery. Most children will need a CBC (complete blood count), blood chemistry, as well as a blood type check . It is very rare to ever need a blood transfusion during this surgery but if one parent is interested in donating blood this needs to be done 7 days prior to surgery and we will direct you in how to do that.
The Night Before Surgery
You will likely be called by the anesthesiologist prior to surgery to discuss any concerns and so they can familiarize themselves with your child’s history. All of the anesthesiologists are Pediatric trained anesthesiologists and there are no other individuals involved in your child’s anesthesia.
Continue your child’s normal routine as much as possible prior to surgery. It is important that you follow the following guidelines for feeding your child prior to surgery:
The Morning of Surgery
You will check in at the main admissions desk at the Rocky Mountain Hospital for Children. They will then direct you to the Pre-op area on the second floor.
Once you have checked in you will meet the nurses who will get your child ready for surgery and the nurses who will take care of your child in the operating room. You will also meet the anesthesiologist who will take care of your child in surgery. Dr. Osterdock will also meet with you again to answer any additional questions and complete the necessary paperwork.
Once your child is taken back to the operating room you will be taken to the waiting room where the nurses will be able to update you throughout the procedure. The anesthesiologist and nurses will be working on starting iv’s and monitors that are necessary for keeping your child safe during the surgery. This can often take an hour just to get everything set up properly for surgery.
The nurse will call out to the waiting room to let you know when the surgery actually begins. The typical operating time is 2-3 hours. The surgery will be performed by Dr. Osterrdock herself, there are no residents or students involved in the surgery. Typically the nurses will update you every hour or so as to how the surgerry is proceeding. Dr. Osterdock will then come out to the waiting room to talk with you as soon as the surgery is complete.
After the surgery your child will either go to the recovery room or directly to the pediatric ICU. There is no difference between the two and this decision is based on nursing and anesthesia. As soon as your child is awake and stable you will be allowed to be with your child. Once your child is awake he/she can be held, talked to, or whatever is soothing. It is common after surgery to have nausea and sometimes vomiting due to the area of surgery. Clear liquids or ice chips can help with dry mouth or thirst. Medications will be used to help control pain and nausea and any other symptoms that may arise. Steroids are also used for the first few days after surgery to help with pain, nausea, and swelling.
The first night in the ICU we will be watching for any signs of neurologic problems that may indicate excessive swelling or other problems. Typically patients are then moved out to the regular pediatric floor for the remainder of their stay. Their activity and diet are gradually increased as the child tolerates. Neck stiffness and pain are usually the major issues during this time and are controlled with pain medications and muscle relaxants if appropriate. Movement is encouraged to help prevent excessive tightness.
The usual hospital stay is 3-4 days and most children are back to normal activity at the time of discharge. Once your child is eating well and able to move around your chld will be discharged home. You will be given prescriptions for medications that your child might need to help be more comfortable at home. You will be able to wash your child’s hair on the second day after surgery. There is no special incision care once you go home but please do not put any ointments or lotions on the incision. The sutures are absorbable and will not need to be removed.
Once You Go Home
Once you go home your child may resume his/her normal activities and diet. Typically restrictions will be no PE or recess in school for 3 months and should avoid strenuous activity. Contact sports are generally not recommended for any child with a Chiari malformation with or without surgery.
You should call the doctor if any of the following occur:
- Fever greater than 101.5
- Your child will not eat or is vomiting excessively
- Severe headaches that do not respond to the prescribed medicines
- There is significant redness or drainage from the incision or any clear fluid leaking from the incision
- You have any concerns that your child is not acting right
You will have a follow-up appointment with Dr. Osterdock 2-3 weeks after surgery. Further follow-up will then be 3 months later and then after that depending on the situation.