title: "Triple R" tonsillar technique for the management of adult Chiari I malformation: surgical note.
abstract: BACKGROUND
  Chiari type I malformation is a congenital disorder that is characterized by the caudal extension of the cerebellar tonsils through the foramen magnum into the cervical canal and by a reduced posterior fossa volume.
  
  
  METHODS
  We report our surgical technique of reposition, reduction, or resection of the cerebellar tonsils for the management of Chiari I malformation. The procedure was performed in 22 adult patients, in three different centers, with a mean age of 37 years. Clinical complaints included headaches, nuchalgia, vertigo, and upper-limb weakness or numbness. Seven patients had cervical syringomyelia. Symptoms developed within a mean time of 36 months (range, 12-70 months).
  
  
  RESULTS
  The cerebellar tonsils were exposed through a dura mater-arachnoid incision at the atlanto-occipital space after a 0.5-cm rimming craniectomy of the occipital bone in all patients. In seven patients the tonsils were resected, in other seven were reduced by subpial coagulation and aspiration, and in the remaining eight patients the tonsils were repositioned after coagulating their surfaces. Three patients had also a posterior fossa arachnoid cyst that was fenestrated in two of them. All patients improved postoperatively. Syringomyelia was reduced in five of seven patients. The mean length of the follow-up period was 12 months.
  
  
  CONCLUSIONS
  Selective reposition, reduction, or resection of herniated cerebellar tonsils may improve symptoms in adult patients with Chiari I malformation.
authors.affiliation: Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, Murcia, Spain.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Galarza
authors.forename: Roberto
authors.initials: R
authors.lastname: Gazzeri
authors.forename: Alex
authors.initials: A
authors.lastname: Alfieri
authors.forename: Juan F
authors.initials: JF
authors.lastname: Martínez-Lage
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001099:Arachnoid / Q000601:surgery; D001139:Arnold-Chiari Malformation / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005539:Foramen Magnum / Q000601:surgery; D006261:Headache / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D014066:Palatine Tonsil / Q000601:surgery*; D011184:Postoperative Period; D013595:Syringomyelia / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult