Chiari I malformation: management evolution and technical innovation.

Abstract

In recent years thanks to the growing use of radiological assessment, Chiari Imalformation became one of the major diseases for a neurosurgeon to deal with. CIM can be classified accordingto the extent of cerebellar tonsil tip into the foramen magnum being a protrusion over five mm consideredpathological. Such a disease is a heterogeneous condition with a multifactorial pathogenetic mechanism that cansubdivided into a primary and secondary form. Regardless of the form, it seems that CIM is the result of animbalance between the volume of the braincase and its content. Acquired CIMs are secondary to conditionscausing intracranial hypertension or hypotension while the pathogenesis of primary forms is still controversial. There are several theories in the literature but the most accepted one implies anovercrowding due to a small posterior cranial fossa. While asymptomatic CIM do not need treatment, symptomatic ones prompt for surgical management. Several techniques are proposed being the dilemma centered in the needfor dural opening procedures and bony decompression ones. Alongside the paper, the authors will address the novelty presented in the literature on management,diagnosis and pathogenesis in order to offer a better understanding of such a heterogeneous pathology.