Treatment of the Adult Chiari I Malformation

Successful surgery for Chiari I malformation in adults requires appropriate patient selection, the identification of the optimal procedure for the specific circumstances of that patient, and careful execution of the surgery. The goal of surgery is to reestablish the unrestricted, pulsatile movement of the cerebrospinal fluid in the subarachnoid space at the craniovertebral junction. This is accomplished almost universally by removing the posterior rim of the foramen magnum and the arch of C1, opening the dura, and placing a pericranial graft to expand the dural space at that level.