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Posterior fossa decompression (PFD) is the primary treatment, although the optimal extent of decompression remains a topic of debate. Intraoperative ultrasonography (IOUS) offers real-time visualization to support informed surgical decision-making. This study aimed to assess the effectiveness and safety of IOUS-guided surgery in CM-I.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review followed PRISMA guidelines and searched the literature up to July 5, 2025. Studies that utilized IOUS and reported related outcomes were included. A random-effects meta-analysis was employed to pool proportions, and a meta-regression analysis was conducted to explore heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-one non-randomized observational studies, including 1,576 patients, 54.4% of whom were female, were included. The pooled clinical improvement rate was 88% (95% CI: 81%\u201393%), and the syrinx improvement\/resolution rate was 87% (95% CI: 77%\u201395%). The pooled reoperation rate was 6% (95% CI: 3%\u20139%), and the complication rate was 6% (95% CI: 3%\u20138%). Meta-regression revealed that longer disease duration, motor\/sensory deficits, and duraplasty were associated with improved syrinx outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>IOUS-guided surgery in CM-I is linked to positive clinical and radiological improvements and low complication rates. IOUS can serve as a helpful tool for customizing decompression during CM-I surgery. Larger, prospective, multi-center studies are needed to confirm these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10072-026-08879-8","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T02:09:24Z","timestamp":1773022164000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative ultrasonography in the surgical management of Chiari I malformation: A systematic review and meta-analysis of outcomes and applications"],"prefix":"10.1007","volume":"47","author":[{"given":"Bardia","family":"Hajikarimloo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Mohammadzadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Amin","family":"Habibi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salem M.","family":"Tos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haris","family":"Yaseen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Chisvo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammadmahdi","family":"Sabahi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qais","family":"Alrashidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Badih","family":"Adada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4640-226X","authenticated-orcid":false,"given":"Hamid","family":"Borghei-Razavi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"issue":"3","key":"8879_CR1","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1002\/ca.23051","volume":"31","author":"F Azahraa Haddad","year":"2018","unstructured":"Azahraa Haddad F, Qaisi I, Joudeh N, Dajani H, Jumah F, Elmashala A et al (2018) The newer classifications of the Chiari malformations with clarifications: an anatomical review. 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