Surgery for Chiari 1 malformation: the Lille experience.

Purpose: Decision-making in chronic tonsillar herniation (CTH) in children is complicated because many cases are diagnosed incidentally; on the other hand, its clinical impact may be underestimated. Furthermore, its surgical management is controversial.
Methods: In the present review, we tried to design a semi-quantitative approach to diagnosis, defining presenting symptoms as compatible, suggestive, or differential diagnoses. We expose our rationale for surgery. We review our experience with extensive posterior fossa decompression (PFD) with systematic dural opening and low threshold for tonsil resection. The aim is to achieve uncontroversial anatomical decompression.
Results: We operated 117 children during the last 10 years. Seventeen had complications, mostly hydraulic and minor; although most resolved without consequences, one patient died of unexplained cerebral vasospasm. At last control, 97% were clinically improved. No patient required reoperation for PFD.
Conclusion: With proper patient selection, extensive PFD is a very efficient operation.