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In this study, we aim to present and evaluate current treatment options for CM\u2010I, with a focus on evidence\u2010based clinical outcomes and emerging surgical techniques. A comprehensive literature review was conducted using a PubMed search with MeSH terms such as \u201cArnold\u2010Chiari Malformation, Type 1,\u201d \u201csyringomyelia,\u201d and \u201cArnold\u2010Chiari malformation*\/surgery.\u201d Original research articles, case reports, systematic reviews, literature reviews, and meta\u2010analyses in English discussing treatments, surgical techniques, anatomical variations, and clinical outcomes were identified to assess the indications, efficacy, and outcomes of various CM\u2010I management strategies. A total of 108 articles were included in the final review, with the majority being retrospective cohort studies, case series, and systematic reviews. Posterior fossa decompression remains the standard surgical treatment of CM\u2010I, with caveats. There is substantial variability in surgical techniques, particularly in clinical decision\u2010making regarding the use of duraplasty, arachnoid dissection, and cerebellar tonsil reduction. Minimally invasive and endoscopic techniques are emerging and have demonstrated promising preliminary outcomes. For managing concurrent pathological conditions, such as hydrocephalus, craniocervical instability, and ventral brainstem compression, the surgical approach should be individualized according to patient\u2010specific conditions. Management of CM\u2010I requires a tailored, symptom\u2010driven approach that should balance efficacy and safety. While posterior fossa decompression, with or without adjunctive surgical techniques depending on patient\u2010specific clinical features and concomitant pathological conditions, remains the standard treatment option, minimally invasive procedures may represent promising alternatives and have shown favorable outcomes in selected patients.<\/jats:p>","DOI":"10.1002\/ca.70079","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T12:17:40Z","timestamp":1769429860000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Chiari I Malformation: Review and Update of Current Treatment Options"],"prefix":"10.1002","author":[{"given":"Jordan J.","family":"Lo","sequence":"first","affiliation":[{"name":"Tulane University School of Medicine  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhei","family":"Shiino","sequence":"additional","affiliation":[{"name":"Tulane University School of Medicine  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen Z.","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tulane Center of Clinical Neurosciences Tulane University School of Medicine  New Orleans Louisiana USA"},{"name":"Department of Neurosurgery and Ochsner Neuroscience Institute Ochsner Health System  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9740-0275","authenticated-orcid":false,"given":"Brianna L.","family":"Hines","sequence":"additional","affiliation":[{"name":"Tulane University School of Medicine  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9521-9878","authenticated-orcid":false,"given":"Noritaka","family":"Komune","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Graduate School of Medical Sciences Kyushu University  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9123-8158","authenticated-orcid":false,"given":"Carmine Antonio","family":"Donofrio","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery ASST Cremona  Cremona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Badaloni","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery IRCCS Istituto Delle Scienze Neurologiche di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Fioravanti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery ASST Cremona  Cremona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Lockwood","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tulane Center of Clinical Neurosciences Tulane University School of Medicine  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. 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