Management of Chiari malformations: opinions from different centers—a review

Purpose: Surgical decision-making in Chiari malformation type I (CM-I) patients tends to depend on the presence of neurological signs and symptoms, syringomyelia, and/or scoliosis, but significant variability exists from center to center. Here, we review the symptoms of CM-I in children and provide an overview of the differences in opinion regarding surgical indications, preferred surgical techniques, and measures of outcome. Methods: A review of the literature was performed to identify publications relevant to the surgical management of pediatric CM-I patients. Results: Most surgeons agree that asymptomatic patients without syringomyelia should not undergo prophylactic surgery, while symptoms of brainstem compression and/or lower cranial nerve dysfunction warrant surgery. Patients between these extremes, however, remain controversial, as does selection of the most appropriate surgical technique. Conclusions: The optimal surgical procedure for children with CM-I remains a point of contention, and widespread variability exists between and within centers.