Minimally invasive subpial tonsillectomy for Chiari I decompression

A number of different surgical techniques have been used through the years to address Chiari I malformation (CMI). This article describes how we surgically manage CMI at two high-volume centers. We call the technique the minimally invasive subpial tonsillectomy (MIST). The technique consists of a minimalistic dissection and craniectomy with a short, linear durotomy for the subpial tonsillar resection. The dura is closed without the use of a duraplasty. We describe our current methods of surgery for CMI.