Surgical Treatment of Chiari I Malformation: Simplified Technique and Clinical Results

A simplified technique for decompressing the posterior fossa and foramen magnum in symptomatic patients with a Chiari I malformation is described. The approach uses a curvilinear dural incision and an autologous pericranial graft. This procedure was used in 14 symptomatic patients, 8 of whom had a cervical or cervicothoracic syrinx. Neurologic signs and symptoms improved or were unchanged in all patients. The size of the syrinx decreased in all patients. No patient developed a new neurologic deficit, cerebrospinal fluid leak, pseudomeningocele, or infection. Postoperatively, one patient developed new, dysesthetic, unilateral arm pain that did not require medication. This technique has several advantages. The procedure is simple and requires a single skin incision. Autologous graft can be used. The occipital sinus can be avoided. Finally, the contralateral region remains pristine if a repeat procedure becomes necessary.