Foramen magnum decompression in pediatric Chiari I malformation without dural repair – uncommon complications and how to avoid them


In symptomatic pediatric patients with Chiari I malformation we perform in our department surgery with small sub-occipital craniectomy, C1 laminectomy, durotomy and arachnoid dissection, without dural closure. Methods: Seventy consecutive operated pediatric patients with Chiari I malformation were included in a single-center study.


The mean age was 10.4 years. Thirty-two patients had syringomyelia and Chiari I malformation. Concomitant scoliosis was present in nineteen patients. Fifty-six patients described postoperative improvement, eleven reported no change, 4 noticed clinical worsening. 7 patients needed revision surgery.


6 patients had CSF leaks, 3 patients aseptic meningitis. Uncommon complications were suboccipital intradiploic CSF collections in 3 cases, intraosseous C2 CSF collection in 1 case and de-novo formation of cervical syrinx in 1 case.

Discussion and Conclusions

In Chiari I decompressive surgery without dural repair the uncommon complications of iatrogenically induced suboccipital intradiploic and intraosseous CSF collections might be avoided by sealing the exposed suboccipital diploe and cortical breaches of the lamina of C2.