Posterior Fossa Decompression Surgery

Now that we have decided on the neurosurgeon to perform the surgery we can focus more on the details of the procedure.  As an interesting side note, the neurologist noticed something on Auggie's MRI from when he was 6 months old - a large vein that is in the very back of the brain (straight sinus - the dark line you see here towards the back of the skull) was almost vertical and is usually at more of an angle - he said that this is sometimes an early indicator of chiari malformation.  We were not told anything about this at the time. 

Here's the MRI from May 2014 that shows the chiari malformation and syrinx. In this image you can see that part of his brain is squeezing down into his spinal canal resulting in a syrinx (light colored bubble in his spine):

As for the surgery itself, the neurosurgeon will shave off part of the bone in the back of the skull in addition to the fourth vertebrae to make room for the brain to move up, then he will probably shrink the bag around the cerebellar tonsils to make them move up into the brain more.  Finally he grafts the dura with Durepair and seals it with Tisseel.  The hope is that there is no CSF leakage or infection.  Other complications include blood loss.  Auggie will spend one night in the ICU followed by about 3 nights in a hospital room.  Full recovery takes about 6 weeks and we return for a follow-up about 2-3 weeks after discharge.  A follow-up MRI is done 3 months after surgery.  I will post more details as we get closer to surgery.