{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T10:57:17Z","timestamp":1780829837250,"version":"3.54.1"},"reference-count":70,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Foramen magnum decompression (FMD) by suboccipital craniectomy, which aims to restore CSF flow and alleviate symptoms, is the conventional treatment for symptomatic Chiari malformation (CM). However, suboccipital cranioplasty is considered to maintain cervical alignment, prevent headaches, improve cosmetic outcomes, and provide protection against trauma. The aim of this study was to compare two surgical techniques, suboccipital craniectomy and suboccipital cranioplasty, to evaluate clinical outcomes, radiological results, and medical costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective analysis included 64 patients (mean age 37.6 \u00b1 12.7 years) who underwent FMD for CM at a single tertiary referral center from January 2003 to March 2024. Patients were divided into two groups according to whether they underwent suboccipital craniectomy or suboccipital cranioplasty. Clinical data, radiological findings, surgical time, estimated blood loss (EBL), and medical costs were analyzed and compared between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Both surgical techniques significantly improved preoperative symptoms, and no significant differences were observed in surgical time or EBL between the groups. Radiologically, the suboccipital craniectomy group demonstrated a greater increase in subarachnoid space (mean 215.3 \u00b1 113.6 mm\n                      <jats:sup>2<\/jats:sup>\n                      ) compared with the suboccipital cranioplasty group (mean 141.4 \u00b1 97.3 mm\n                      <jats:sup>2<\/jats:sup>\n                      , p = 0.008), although the reduction in syrinx size was similar for both groups. The suboccipital cranioplasty group incurred higher daily medical costs (mean $1568.4 \u00b1 $455.5) compared with the suboccipital craniectomy group (mean $887.1 \u00b1 $340.5, p &lt; 0.001), primarily due to the additional expenses related to bony reconstruction materials such as plates and screws (mean $343.3 \u00b1 $81.6).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Suboccipital craniectomy and cranioplasty both effectively improve symptoms for patients with CM. However, suboccipital cranioplasty involves additional costs, which should be discussed in the shared decision-making process.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.2.spine241362","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T22:30:24Z","timestamp":1748039424000},"page":"237-245","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of suboccipital craniectomy versus suboccipital cranioplasty in foramen magnum decompression for adult Chiari malformation"],"prefix":"10.3171","volume":"43","author":[{"given":"Hangeul","family":"Park","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Hospital, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woojin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Hospital, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jungbo","family":"Sim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Hospital, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hosung","family":"Myeong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Hospital, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Hoe","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Hospital, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-Hyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Hospital, Seoul;"},{"name":"Department of Neurosurgery, Seoul National University College of Medicine, Seoul;"},{"name":"Medical Big Data Research Center, Seoul National University Medical Research Center, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun Kee","family":"Chung","sequence":"additional","affiliation":[{"name":"Neuroscience Research Institute, Seoul National University College of Medicine, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi Heon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Hospital, Seoul;"},{"name":"Department of Neurosurgery, Seoul National University College of Medicine, Seoul;"},{"name":"Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Br J Neurosurg","first-page":"737","article-title":"Foramen magnum decompression for Chiari malformation type I \u2013 UK surgical practice","volume":"36","author":"Giannakaki V","year":"2022","unstructured":"Giannakaki V, Nissen J. Foramen magnum decompression for Chiari malformation type I \u2013 UK surgical practice. Br J Neurosurg. 2022;36(6):737\u2013742."},{"issue":"7","key":"b2","series-title":"Childs Nerv Syst","first-page":"833","article-title":"Correlation of hindbrain CSF flow and outcome after surgical decompression for Chiari I malformation","volume":"24","author":"McGirt MJ","year":"2008","unstructured":"McGirt MJ, Atiba A, Attenello FJ,  Correlation of hindbrain CSF flow and outcome after surgical decompression for Chiari I malformation. Childs Nerv Syst. 2008;24(7):833\u2013840."},{"key":"b3","series-title":"World Neurosurg","first-page":"213","article-title":"Chiari malformation type 1: a systematic review of natural history and conservative management","volume":"104","author":"Langridge B","year":"2017","unstructured":"Langridge B, Phillips E, Choi D. Chiari malformation type 1: a systematic review of natural history and conservative management. World Neurosurg. 2017;104:213\u2013219."},{"issue":"6","key":"b4","series-title":"Neurosurgery","first-page":"E552","article-title":"Failed foramen magnum decompression in Chiari I malformation is associated with failure to restore normal intracranial compliance: an observational cohort study","volume":"86","author":"Dyson EW","year":"2020","unstructured":"Dyson EW, Chari A, Toma AK, Thorne LW, Watkins LD. Failed foramen magnum decompression in Chiari I malformation is associated with failure to restore normal intracranial compliance: an observational cohort study. Neurosurgery. 2020;86(6):E552\u2013E557."},{"key":"b5","series-title":"World Neurosurg","first-page":"7","article-title":"A systematic review of Chiari I malformation: techniques and outcomes","volume":"88","author":"Zhao JL","year":"2016","unstructured":"Zhao JL, Li MH, Wang CL, Meng W. A systematic review of Chiari I malformation: techniques and outcomes. World Neurosurg. 2016;88:7\u201314."},{"issue":"1","key":"b6","series-title":"Neurosurg Rev","first-page":"311","article-title":"The effect of posterior fossa decompression in adult Chiari malformation and basilar invagination: a systematic review and meta-analysis","volume":"41","author":"de Oliveira Sousa U","year":"2018","unstructured":"de Oliveira Sousa U, de Oliveira MF, Heringer LC, Barcelos ACES, Botelho RV. The effect of posterior fossa decompression in adult Chiari malformation and basilar invagination: a systematic review and meta-analysis. Neurosurg Rev. 2018;41(1):311\u2013321."},{"key":"b7","series-title":"BioMed Res Int","first-page":"9770323","article-title":"A clinical study on the treatment of recurrent Chiari (type I) malformation with syringomyelia based on the dynamics of cerebrospinal fluid","volume":"2022","author":"Lou Y","year":"2022","unstructured":"Lou Y, Yang J, Gu H,  A clinical study on the treatment of recurrent Chiari (type I) malformation with syringomyelia based on the dynamics of cerebrospinal fluid. BioMed Res Int. 2022;2022:9770323."},{"key":"b8","series-title":"Neurosurgical Procedures \u2013 Innovative Approaches","article-title":"Role of cranioplasty in management of Chiari malformation","author":"Asifur R","year":"2020","unstructured":"Asifur R. Role of cranioplasty in management of Chiari malformation. In: Alba S, De Pasquale B, eds.Neurosurgical Procedures \u2013 Innovative Approaches. IntechOpen; 2020."},{"issue":"3","key":"b9","series-title":"Neurol Res","first-page":"261","article-title":"Posterior fossa decompression and reconstruction in adolescents and adults with the Chiari I malformation","volume":"33","author":"Or\u00f3 JJ","year":"2011","unstructured":"Or\u00f3 JJ, Mueller DM. Posterior fossa decompression and reconstruction in adolescents and adults with the Chiari I malformation. Neurol Res. 2011;33(3):261\u2013271."},{"issue":"1","key":"b10","series-title":"Am J Roentgenol Radium Ther Nucl Med","first-page":"23","article-title":"Occipitalization of the atlas","volume":"70","author":"McRae DL","year":"1953","unstructured":"McRae DL, Barnum AS. Occipitalization of the atlas. Am J Roentgenol Radium Ther Nucl Med. 1953;70(1):23\u201346."},{"issue":"2","key":"b11","series-title":"Neurospine","first-page":"510","article-title":"Magnetic resonance imaging-related anatomic and functional parameters for the diagnosis and prognosis of Chiari malformation type I: a systematic review and meta-analysis","volume":"21","author":"Wang Z","year":"2024","unstructured":"Wang Z, Li Z, Han S,  Magnetic resonance imaging-related anatomic and functional parameters for the diagnosis and prognosis of Chiari malformation type I: a systematic review and meta-analysis. Neurospine. 2024;21(2):510\u2013524."},{"issue":"3","key":"b12","series-title":"Neurosurgery","first-page":"656","article-title":"A novel scoring system for assessing Chiari malformation type I treatment outcomes","volume":"70","author":"Aliaga L","year":"2012","unstructured":"Aliaga L, Hekman KE, Yassari R,  A novel scoring system for assessing Chiari malformation type I treatment outcomes. Neurosurgery. 2012;70(3):656\u2013665."},{"issue":"3","key":"b13","series-title":"Neurospine","first-page":"816","article-title":"Phenotypes and prognostic factors of syringomyelia in single-center patients with Chiari I malformation: moniliform type as a special configuration","volume":"19","author":"Lu C","year":"2022","unstructured":"Lu C, Ma L, Yuan C,  Phenotypes and prognostic factors of syringomyelia in single-center patients with Chiari I malformation: moniliform type as a special configuration. Neurospine. 2022;19(3):816\u2013827."},{"issue":"4","key":"b14","series-title":"Neurospine","first-page":"1057","article-title":"Relationship between syrinx resolution and cervical sagittal realignment following decompression surgery for Chiari I malformation related syringomyelia based on configuration phenotypes","volume":"19","author":"Lu C","year":"2022","unstructured":"Lu C, Ma L, Guan J,  Relationship between syrinx resolution and cervical sagittal realignment following decompression surgery for Chiari I malformation related syringomyelia based on configuration phenotypes. Neurospine. 2022;19(4):1057\u20131070."},{"issue":"19","key":"b15","series-title":"Spine (Phila Pa 1976).","first-page":"E1063","article-title":"The selection of open or percutaneous endoscopic lumbar discectomy according to an age cut-off point: nationwide cohort study","volume":"40","author":"Kim CH","year":"2015","unstructured":"Kim CH, Chung CK, Choi Y,  The selection of open or percutaneous endoscopic lumbar discectomy according to an age cut-off point: nationwide cohort study. Spine (Phila Pa 1976).2015;40(19):E1063\u2013E1070."},{"issue":"1","key":"b16","series-title":"Sci Rep","first-page":"1295","article-title":"Screening patients requiring secondary lumbar surgery for degenerative lumbar spine diseases: a nationwide sample cohort study","volume":"14","author":"Park H","year":"2024","unstructured":"Park H, Lee J, Choi Y,  Screening patients requiring secondary lumbar surgery for degenerative lumbar spine diseases: a nationwide sample cohort study. Sci Rep. 2024;14(1):1295."},{"issue":"3","key":"b17","series-title":"J Neurosurg Spine","first-page":"301","article-title":"The iterative implementation of a comprehensive enhanced recovery after surgery protocol in all spinal surgery in Korea: a comparative analysis of clinical outcomes and medical costs between primary spinal tumors and degenerative spinal diseases","volume":"40","author":"Yuh WT","year":"2023","unstructured":"Yuh WT, Kim JH, Han J,  The iterative implementation of a comprehensive enhanced recovery after surgery protocol in all spinal surgery in Korea: a comparative analysis of clinical outcomes and medical costs between primary spinal tumors and degenerative spinal diseases. J Neurosurg Spine. 2023;40(3):301\u2013311."},{"issue":"32","key":"b18","series-title":"Pediatr Neurol","first-page":"37","article-title":"Prevalence and impact of underlying diagnosis and comorbidities on Chiari 1 malformation","volume":"106","author":"Sadler B","year":"2020","unstructured":"Sadler B, Kuensting T, Strahle J,  Prevalence and impact of underlying diagnosis and comorbidities on Chiari 1 malformation. Pediatr Neurol. 2020;106(32):37."},{"key":"b19","series-title":"World Neurosurg","first-page":"e784","article-title":"Foramen magnum decompression for Chiari malformation type 1: is there a superior surgical technique?","volume":"170","author":"Giannakaki V","year":"2023","unstructured":"Giannakaki V, Wildman J, Thejasvin K,  Foramen magnum decompression for Chiari malformation type 1: is there a superior surgical technique? World Neurosurg. 2023;170:e784\u2013e790."},{"issue":"10","key":"b20","series-title":"Cureus","first-page":"e47301","article-title":"The pathogenesis of Chiari malformation and syringomyelia: a case report and systematic review of current theories","volume":"15","author":"Sivakumaran P","year":"2023","unstructured":"Sivakumaran P, Ashwood N, Kamal M, Jayakumar N. The pathogenesis of Chiari malformation and syringomyelia: a case report and systematic review of current theories. Cureus. 2023;15(10):e47301."},{"key":"b21","first-page":"59","article-title":"A less invasive suboccipital decompression-cranioplasty for Chiari type I malformation: is it beneficial? Interdiscip Neurosurg","volume":"14","author":"Mahadewa Tjokorda GB","year":"2018","unstructured":"Mahadewa Tjokorda GB, Senapathi Tjokorda GA. A less invasive suboccipital decompression-cranioplasty for Chiari type I malformation: is it beneficial? Interdiscip Neurosurg. 2018;14:59\u201362."},{"issue":"5","key":"b22","series-title":"J Korean Neurosurg Soc","first-page":"512","article-title":"Surgical outcome of adult idiopathic Chiari malformation type 1","volume":"59","author":"Yuh WT","year":"2016","unstructured":"Yuh WT, Kim CH, Chung CK, Kim HJ, Jahng TA, Park SB. Surgical outcome of adult idiopathic Chiari malformation type 1. J Korean Neurosurg Soc. 2016;59(5):512\u2013517."},{"issue":"2","key":"b23","series-title":"Neurol Clin","first-page":"297","article-title":"Chiari malformation (update on diagnosis and treatment)","volume":"40","author":"Rosenblum JS","year":"2022","unstructured":"Rosenblum JS, Pomeraniec IJ, Heiss JD. Chiari malformation (update on diagnosis and treatment). Neurol Clin. 2022;40(2):297\u2013307."},{"issue":"4","key":"b24","series-title":"Neurospine","first-page":"1501","article-title":"Individualized functional decompression options for adult Chiari malformation with syringomyelia and a novel scale for syringomyelia resolution: a single-center experience","volume":"20","author":"Han S","year":"2023","unstructured":"Han S, Hou B, Li Z, Feng F, Li Y, Gao J. Individualized functional decompression options for adult Chiari malformation with syringomyelia and a novel scale for syringomyelia resolution: a single-center experience. 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J Neurosurg. 2013;118(2):232\u2013242."},{"issue":"1","key":"b27","series-title":"Sci Rep","first-page":"19152","article-title":"An increase in the posterior subarachnoid space accelerates the timing of syrinx resolution after foramen magnum decompression of type I Chiari malformation","volume":"11","author":"Ohnishi Y","year":"2021","unstructured":"Ohnishi Y, Fujiwara S, Takenaka T, Kawamoto S, Iwatsuki K, Kishima H. An increase in the posterior subarachnoid space accelerates the timing of syrinx resolution after foramen magnum decompression of type I Chiari malformation. Sci Rep. 2021;11(1):19152."},{"key":"b28","series-title":"Acta Neurochir Suppl (Wien)","first-page":"22","article-title":"Operative treatment of Chiari malformation with syringomyelia","volume":"43","author":"Tokuno H","year":"1988","unstructured":"Tokuno H, Hakuba A, Suzuki T, Nishimura S. Operative treatment of Chiari malformation with syringomyelia. 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Expansive suboccipital cranioplasty in Chiari 1 malformation (a case report and technical notes). Article in Russian. Zh Vopr Neirokhir Im N N Burdenko. 2017;81(4):108\u2013112."},{"issue":"1","key":"b33","series-title":"Surg Neurol","first-page":"63","article-title":"Simple and safe method of cranial reconstruction after posterior fossa craniectomy","volume":"65","author":"Sheikh BY","year":"2006","unstructured":"Sheikh BY. Simple and safe method of cranial reconstruction after posterior fossa craniectomy. Surg Neurol. 2006;65(1):63\u201366."},{"key":"b34","series-title":"Syringomyelia","first-page":"188","article-title":"Surgical treatment of syringomyelia associated with Chiari I malformation: advantage of cranioplasty using hydroxyapatite implants","author":"Itoh Y","year":"2001","unstructured":"Itoh Y, Kuwahara N, Hirano Y, Sasajima T, Suzuki A, Mizoi K. Surgical treatment of syringomyelia associated with Chiari I malformation: advantage of cranioplasty using hydroxyapatite implants. In: Tamaki N, Batzdorf U, Nagashima T, eds.Syringomyelia. Springer Japan;2001:188-193."},{"issue":"6","key":"b35","series-title":"Neurosurg Focus","first-page":"E12","article-title":"Acute respiratory arrest following partial suboccipital cranioplasty for cerebellar ptosis from Chiari malformation decompression","volume":"25","author":"Di X","year":"2008","unstructured":"Di X, Luciano MG, Benzel EC. Acute respiratory arrest following partial suboccipital cranioplasty for cerebellar ptosis from Chiari malformation decompression. Neurosurg Focus. 2008;25(6):E12."},{"issue":"6","key":"b1","series-title":"Br J Neurosurg","first-page":"737","article-title":"Foramen magnum decompression for Chiari malformation type I \u2013 UK surgical practice","volume":"36","author":"Giannakaki V","year":"2022","unstructured":"Giannakaki V, Nissen J. Foramen magnum decompression for Chiari malformation type I \u2013 UK surgical practice. Br J Neurosurg. 2022;36(6):737\u2013742."},{"issue":"7","key":"b2","series-title":"Childs Nerv Syst","first-page":"833","article-title":"Correlation of hindbrain CSF flow and outcome after surgical decompression for Chiari I malformation","volume":"24","author":"McGirt MJ","year":"2008","unstructured":"McGirt MJ, Atiba A, Attenello FJ,  Correlation of hindbrain CSF flow and outcome after surgical decompression for Chiari I malformation. Childs Nerv Syst. 2008;24(7):833\u2013840."},{"key":"b3","series-title":"World Neurosurg","first-page":"213","article-title":"Chiari malformation type 1: a systematic review of natural history and conservative management","volume":"104","author":"Langridge B","year":"2017","unstructured":"Langridge B, Phillips E, Choi D. Chiari malformation type 1: a systematic review of natural history and conservative management. World Neurosurg. 2017;104:213\u2013219."},{"issue":"6","key":"b4","series-title":"Neurosurgery","first-page":"E552","article-title":"Failed foramen magnum decompression in Chiari I malformation is associated with failure to restore normal intracranial compliance: an observational cohort study","volume":"86","author":"Dyson EW","year":"2020","unstructured":"Dyson EW, Chari A, Toma AK, Thorne LW, Watkins LD. Failed foramen magnum decompression in Chiari I malformation is associated with failure to restore normal intracranial compliance: an observational cohort study. Neurosurgery. 2020;86(6):E552\u2013E557."},{"key":"b5","series-title":"World Neurosurg","first-page":"7","article-title":"A systematic review of Chiari I malformation: techniques and outcomes","volume":"88","author":"Zhao JL","year":"2016","unstructured":"Zhao JL, Li MH, Wang CL, Meng W. A systematic review of Chiari I malformation: techniques and outcomes. World Neurosurg. 2016;88:7\u201314."},{"issue":"1","key":"b6","series-title":"Neurosurg Rev","first-page":"311","article-title":"The effect of posterior fossa decompression in adult Chiari malformation and basilar invagination: a systematic review and meta-analysis","volume":"41","author":"de Oliveira Sousa U","year":"2018","unstructured":"de Oliveira Sousa U, de Oliveira MF, Heringer LC, Barcelos ACES, Botelho RV. The effect of posterior fossa decompression in adult Chiari malformation and basilar invagination: a systematic review and meta-analysis. 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Am J Roentgenol Radium Ther Nucl Med. 1953;70(1):23\u201346."},{"issue":"2","key":"b11","series-title":"Neurospine","first-page":"510","article-title":"Magnetic resonance imaging-related anatomic and functional parameters for the diagnosis and prognosis of Chiari malformation type I: a systematic review and meta-analysis","volume":"21","author":"Wang Z","year":"2024","unstructured":"Wang Z, Li Z, Han S,  Magnetic resonance imaging-related anatomic and functional parameters for the diagnosis and prognosis of Chiari malformation type I: a systematic review and meta-analysis. Neurospine. 2024;21(2):510\u2013524."},{"issue":"3","key":"b12","series-title":"Neurosurgery","first-page":"656","article-title":"A novel scoring system for assessing Chiari malformation type I treatment outcomes","volume":"70","author":"Aliaga L","year":"2012","unstructured":"Aliaga L, Hekman KE, Yassari R,  A novel scoring system for assessing Chiari malformation type I treatment outcomes. Neurosurgery. 2012;70(3):656\u2013665."},{"issue":"3","key":"b13","series-title":"Neurospine","first-page":"816","article-title":"Phenotypes and prognostic factors of syringomyelia in single-center patients with Chiari I malformation: moniliform type as a special configuration","volume":"19","author":"Lu C","year":"2022","unstructured":"Lu C, Ma L, Yuan C,  Phenotypes and prognostic factors of syringomyelia in single-center patients with Chiari I malformation: moniliform type as a special configuration. Neurospine. 2022;19(3):816\u2013827."},{"issue":"4","key":"b14","series-title":"Neurospine","first-page":"1057","article-title":"Relationship between syrinx resolution and cervical sagittal realignment following decompression surgery for Chiari I malformation related syringomyelia based on configuration phenotypes","volume":"19","author":"Lu C","year":"2022","unstructured":"Lu C, Ma L, Guan J,  Relationship between syrinx resolution and cervical sagittal realignment following decompression surgery for Chiari I malformation related syringomyelia based on configuration phenotypes. 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