Subcerebellar tonsillar hernia surgery carries some risks that need to be discussed with your doctor before surgery.
Subcerebellar tonsillar herniation occurs when brain tissue, such as the cerebellum, goes down into the greater occipital foramen and even presses on the brain stem, such as the medulla oblongata. Because there are many important neurovascular and brain tissues in this area, this type of surgery is riskier and has a higher rate of surgical complications.
Common complications mainly include aseptic meningitis (32.38%), cerebrospinal fluid leakage (21.31%), incision infection (7.38%), and hydrocephalus (5.74%), with a case-fatality rate of less than 1% and a neurologic symptom recurrence rate of 7% to 11%, and when the bony window is too large (greater than 4 cm × 4 cm), the cerebellum is likely to experience further downward displacement after the operation.
In order to reduce the risk of surgery, attention needs to be paid to the surgical position to avoid excessive neck flexion, familiarity with the local anatomical structure, intraoperative aseptic operation, tight suturing of all layers of tissues, and the use of glue to reinforce the dura after suturing the dura with duraplasty can effectively prevent postoperative complications. The safety of the surgery will be increased if it is performed by an experienced surgeon in a large hospital with strong neurosurgical capabilities.
The safety of the surgery is also related to the patient’s physical condition and underlying disease. If the patient is young, in good physical condition, and has no underlying diseases such as hypertension, diabetes, or cerebral infarction, then the surgery is safer.
Patients with subcerebellar tonsillar herniation who do not have any symptoms can be closely observed, followed up regularly in the hospital, and do not need surgery for the time being. If there is a change in the condition, go to the hospital immediately and the doctor will decide in person whether surgery is needed.