Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Patients With Chiari Malformation: Symptoms

Neurosurgery. 2023 Oct 1;93(4):727-730. doi: 10.1227/neu.0000000000002634. Epub 2023 Aug 30.


Background: Chiari I malformation (CIM) is characterized by descent of the cerebellar tonsils through the foramen magnum, potentially causing symptoms from compression or obstruction of the flow of cerebrospinal fluid. Diagnosis and treatment of CIM is varied, and guidelines produced through systematic review may be helpful for clinicians.

Objective: To perform a systematic review of the medical literature to answer specific questions on the diagnosis and treatment of CIM.

Methods: PubMed and Embase were queried between 1946 and January 23, 2021, using the search strategies provided in Appendix I of the full guidelines.

Results: The literature search yielded 430 abstracts, of which 79 were selected for full-text review, 44 were then rejected for not meeting the inclusion criteria or for being off-topic, and 35 were included in this systematic review.

Conclusion: Four Grade C recommendations were made based on Class III evidence, and 1 question had insufficient evidence. The full guidelines can be seen online at .

Publication types

  • Systematic Review

MeSH terms

  • Arnold-Chiari Malformation* / diagnosis
  • Arnold-Chiari Malformation* / surgery
  • Evidence Gaps
  • Foramen Magnum
  • Humans
  • Neurosurgeons*
  • Patients