ABSTRACT
The Chiari malformations are a diverse group of anomalies in which a mismatch between the posterior fossa neural and bony elements may result in a relative descent of the cerebellar tonsils through the foramen magnum. A decompression of the foramen magnum, often paired with a C1 laminectomy and duraplasty, is the standard procedure offered, although many variations in surgical technique exist. Patient expectations of revision suboccipital decompression surgery in patients with Chiari malformation require significant patient counseling. The degree of suboccipital and upper cervical decompression required should be determined by the patient's clinical findings, in conjunction with the anatomy/radiographic findings, and the degree to which neural tissue is compressed. Postoperatively, patients should be observed in an intensive care unit setting for hourly neurologic and vital monitoring checks. Given the unpredictable interfaces of hard, bony edges with scar/dura/duraplasty, monopolar cautery should be limited when approaching the regions during revision surgeries.
