Posterior fossa decompression and reconstruction in adolescents and adults with the Chiari I malformation.

ABSTRACT

OBJECTIVE: The purpose of this paper is to review the current and historical surgical approaches to treating Chiari I malformation in adolescents and adults. METHODS: A PubMed literature review and the author's own surgical experiences serve as a basis for discussing the variability in the surgical treatment of the Chiari I malformation. RESULTS: The most common treatment of the Chiari I malformation is posterior fossa decompression, which can range from a minimally invasive extradural approach to durotomy, duraplasty, internal decompression, and cranioplasty. Other surgical procedures may be required depending on the presence of associated conditions such as hydrocephalus, severe basilar invagination, or craniocervical instability. CONCLUSIONS: There is no consensus on the procedural steps that lead to a consistently favorable outcome. However, the growth in surgical research in this field should allow better selection of the most effective surgical approach for each patient.