• Claudio H F Vidal, Alessandra M Brainer-Lima, Marcelo M Valença, and Farias Ronald de Lucena RL Department of Anatomy, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil..
• Department of Neurosurgery, Getúlio Vargas Hospital, Recife, Pernambuco, Brazil. Electronic address: chfvidalncr@gmail.com.
• World Neurosurg. 2019 Jan 1; 121: e605-e613.

ObjectiveEvidence is lacking concerning the myriad surgical techniques for type 1 Chiari malformation. This study evaluated the impact of arachnoid violation with tonsil thermocoagulation during surgical craniovertebral junction decompression.MethodsThe evaluation included aspects of the neurologic examination and parameters of cerebrospinal fluid flow on magnetic resonance imaging during preoperative and postoperative periods. All patients underwent craniovertebral junction decompression and opening of the dura mater. Patients were divided into 2 study groups. Patients in group 1 did not undergo arachnoid violation. Patients in group 2 underwent tonsil manipulation and systematic opening of the fourth ventricle outlet.ResultsThere were 16 patients enrolled in each group (total of 32 patients). Regarding clinical improvement, there were no significant differences between groups in the postoperative period. Group 2 had more adverse events (relative risk 2.45, 95% confidence interval 1.55-3.86). In terms of cerebrospinal fluid flow parameter analyses, patients in group 1 achieved better results (P < 0.05).ConclusionsFor treatment of symptomatic type 1 Chiari malformation, craniovertebral junction decompression with arachnoid preservation (i.e., without tonsillar manipulation) seems more suitable than the addition of arachnoid opening and thermocoagulation of the tonsils.Copyright © 2018 Elsevier Inc. All rights reserved.

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