Chiari I malformations are the most common anomalies of the craniocervical junction. Many surgical techniques have been recommended, but the optimal treatment strategy for these patients is still under debate. In this report, we describe the surgical steps for posterior fossa decompression we usually perform at our department. The surgical technique is demonstrated in three cases of children with Chiari malformation Type I. Posterior fossa decompression was achieved by decompressive suboccipital craniectomy, C1 laminectomy, and duraplasty. Cerebellar tonsil resection was performed to obtain visualization of the obex and arachnoid membranes were removed to preserve an unimpaired cerebrospinal fluid (CSF) circulation.

The children all had good and very good postoperative clinical results. Remarkable improvement of neurological deficits was observed and radiological benefit was documented.

In our opinion, the described strategy is an effective way to achieve decompression of the craniocervical junction and to restore normal CSF dynamics. Good and very good postoperative results could be documented, but optimal treatment management will still be a matter of debate.