This chapter describes the goals, investigations, premedication, intravenous access and induction of the Arnold–Chiari malformation. It also describes the maintenance, positioning, intravenous fluids and postoperative analgesia of the Arnold–Chiari malformation. The chapter explains the complete medical history, including cardiac and pulmonary function, to decrease perioperative morbidity and mortality. It focuses on the magnetic resonance imaging (MRI) for visualization of posterior fossa anatomical structures. The chapter discusses the careful physical examination for signs of increased ICP and trophic lesions in skin that may limit venous access. It also explains the routine investigations, including completed blood count (CBC), blood chemistry, coagulation profile, electrocardiogram (ECG), and chest X-ray (CXR). The chapter also focuses on the narcotics-based technique with inhalational agents such as sevoflurane and desflurane. It considers the neostigmine and glycopyrrolate to reverse the effect of neuromuscular blockade before extubation.