• Eloy Rusafa Neto, Wellingson Silva Paiva, Róger Schimidt Brock, Cintya Yukie Hayashi, Marcia Mitie Nagumo, Maurício Oriente Segurado, Ana Luiza Zaninotto, and Róbson Luis Amorim.
• Department of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil. Electronic address: eloyrusafa@me.com.
• World Neurosurg. 2024 Feb 1; 182: e178e185e178-e185.

ObjectiveThis pilot study aimed to investigate the role of Posterior Fossa Decompression (PFD) on the intracranial pressure (ICP) waveform in patients with Chiari Malformation type 1 (CM1). It also sought to explore the relationship between symptom improvement and ICP waveform behavior.MethodsThis exploratory cohort study evaluated adult patients diagnosed with CM1. The patients underwent PFD using a standard technique at our institution, which involved a 3 × 3 cm posterior craniectomy and excision of the posterior arch of C1. The ICP waveform was measured using an external strain-gauge device connected to a pin attached to the skull. Measurements were collected pre- and post-PFD, and the P2/P1 ratio was calculated pre- and postoperatively.ResultsThe pilot study comprised 6 participants, 3 men and 3 women, with ages ranging from 39 to 68 years. The primary symptoms were cerebellar ataxia and typical headaches. The study found that most patients who showed clinical improvement, as judged by the Gestalt method, had a postoperative decrease in the P2/P1 ratio. However, 1 patient did not show an improvement in the P2/P1 ratio despite a good clinical outcome.ConclusionsThis study suggests that the P2/P1 ratio may decrease after PFD. However, we highlight the need for further research with a larger sample size to confirm these preliminary results.Copyright © 2023 Elsevier Inc. All rights reserved.

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