Commentary

This is another variation on procedures for decompression of the posterior fossa for the treatment of Chiari I malformations. The bony decompression is the same as in other procedures. The authors, however, limit the dural opening and arachnoidal dissection and then make a dural graft from autologous pericranium. After treatment most of their patients improved, and all syringes resolved. The procedure requires a larger incision than usual but avoids using foreign materials for dural grafts and limits subarachnoid scarring. It is important to remember that the decompression must include the entire region that appears to be restricted on preoperative magnetic resonance imaging.