The entity of Chiari Malformation: Literature overview and presentation of the 50 most cited relevant papers.

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Dimitrios Panagopoulos Georgios Strantzalis Maro Gavra Boviatsis Efstathios Stefanos Korfias Ploutarchos Karydakis


Chiari malformations comprise a group of disorders, which share in common inherent anatomical abnormalities that involve the region of the brain stem and cerebellum, eventually coexisting with entities such as hydrocephalus, spina bifida, syringomyelia and tethered cord syndrome.In the mean-time, from the original description of this syndrome, several researchers have focused on an effort to elucidate the pathogenesis of Chiari malformation from a point of view that it is a primary neural anomaly.

The aim of the current review is to investigate the time course of our knowledge regarding Chiari malformation, which has expanded significant in the past decades. As new insight has occurred regarding the pathophysiology and natural history of Chiari I malformation (CIM), in association with the widespread availability of MRI,the treatment modalities and algorithm for this patient population has been substantially evolved.Our purpose is to present a review of CIM and its most significant associated comorbidities,comment on techniques for surgical intervention and their expected outcomes.

There is a bulk of literature reviews centered on Chiari malformations· in this context, we attempted a literature review, including a discussion centered onthe historical background, anatomical forms, pathophysiology, clinical presentation, relationships with other diseases and diagnostic procedures for these abnormalities. Moreover, a bibliographic search was performed, using Thomson Reuters web of Science and Pubmed databases, in order to identify the most noteworthy papers about Chiari Syndrome. The following parameters were recorded: article titles, number of total citations and citations per year, authors’ names, authors’ h-index, institution and country where the research took place, year of publication, the journal of publication and journal’s impact factor. In addition, we reviewed the journals’ Impact Factor and SCImago Journal Rank (SJR). To obtain all those parameters, besides Web of sciences, we utilized Scopus, SCimago Journal and Country rankings, and In Cites Journal Citation Reports.

Our search resulted in 9.972 articles, published from 1855 until now (March2022). All articles are in English. The 50 most cited papers are presented in Table S1. All of them combined have been cited 8.999 times, in 3.262 different articles, with an average citation per item of 179.98.

We have attempted to present a thorough overview of this group of disorders, as well as to trace the evolution of our knowledge regarding the anatomical abnormalities associated with this condition, imaging and treatment gold standards and future perspectives.

The real pathophysiology, embryological background and natural history of CM have still not been entirely elucidated. This is in concordance with the fact that new suggestions have been submitted for the management of this malformation and more sophisticated imaging techniques have been introduced, in order to investigate in more details, the diagnosis. However, a lot of controversies remain, mainly centered on the optimum strategy which should be selected for selection of the appropriate surgical candidates and most efficacious treatment protocols, in order to obtain efficient decompression of the cranio-cervical junction.

Keywords: Analysis, Articles, Bibliometric, Citation, Chiari malformation, syringomyelia, duraplasty, suboccipital decompression

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PANAGOPOULOS, Dimitrios et al. The entity of Chiari Malformation: Literature overview and presentation of the 50 most cited relevant papers.. Medical Research Archives, [S.l.], v. 10, n. 5, june 2022. ISSN 2375-1924. Available at: <>. Date accessed: 23 may 2024. doi:
Review Articles


1. Mancarella C, Delfini R, Landi A. Chiari Malformations. Acta Neurochir Suppl. 2019;(125):89-95. doi: 10.1007/978-3-319-62515-7_13.
2. Chiari H. Concerning alterations in the cerebellum resulting from cerebral hydrocephalus (translated by A. Radkowski). PediatrNeurosci1987;(13):3–8.
3. Chiari H. Uber Veranderungen des Kleinhirnsinfolge von Hydrocephalie des Grosshims. Dtsch Med Wochenschr1891;(17):1172–5.
4. Chiari H. Uber Veranderungen des Kleinhirns, der Pons und der Medulla oblongata infolge von congenitalerHydrocephalie des Grosshirns. DenkschrAkadWiss Wien. 1895;(63):71–115.
5. Milhorat TH, Chou M.W, Trinidad EM, Kula RW, Mandell M, Wolpert C, Speer MC. Chiari I Malformation Redefined: Clinical and Radiographic Findings for 364 Symptomatic Patients. Neurosurgery 1999; 44(5)ː1005–1017
6. Cleland J. Contribution to the study of spina bifida, encephalocele, and anencephalus. J Anat Physiol. 1883;(17) (Pt 3):257–92 PMCID: PMC1310092.
7. Bejjani GK. Definition of the adult Chiari malformation: a brief historical overview. Neurosurg Focus2001;(11):1–8.
8. Carey M, Fuell W, Harkey T, Gregory W. Albert G.W. Natural history of Chiari I malformation in children: a retrospective analysis. Childs Nerv Syst. 2021;37(4):1185-1190.
9. Gardner WJ. Hydrodynamic mechanism of syringomyelia: its relationship to myelocele. J Neurol Neurosurg Psychiatry 1965;28(3):247-59. doi: 10.1136/jnnp.28.3.247.
10. Williams B. Cerebrospinal fluid pressure-gradients in spina bifida cystica, with special reference to the Arnold-Chiari malformation and aqueductal stenosis. Dev Med Child Neurol Suppl 1975;(35):138-50. doi: 10.1111/j.1469-8749. 1975. tb03594. x.
11. McLone DG, Knepper PA. The cause of Chiari II malformation: a unified theory. PediatrNeurosci. 1989;15(1):1-12. doi: 10.1159/000120432.
12. Shoja MM, Johal J, Oakes JW, Tubbs SR. Embryology and pathophysiology of the Chiari I and II malformations: A comprehensive review. Clin Anat 2018;31(2):202-215doi: 10.1002/ca.22939. Epub 2017 Dec 4.
13. Nishikawa M, Sakamoto H, Hakuba A, Nakanishi N, Inoue Y. Pathogenesis of Chiari malformation: a morphometric study of the posterior cranial fossa. J Neurosurg 1997;86(1):40-7. doi: 10.3171/jns.1997.86.1.0040.
14. Stovner U, Bergan U, Nilsen G, Sjaastad O: Posterior cranial fossa dimensions in the Chiari I malformation: relation to pathogenesis and clinical presentation. Neuroradiol 1993;(35):113-118.
15. Vega A, Quintana F, Berciano J: Basichondrocraniumllll anomalies in adult Chiari type I malformation: a morphometric study. J Neurol Sci 1990;(99):137-145.
16. O'Rahilly R, Muller F, Meyer DB: The human vertebral column at the end of the embryonic period proper. The occipito-cervical region. J. Anat 1983;(136):181-195.
17. Oldfield EH, Muraszko K, Shawker TH, Patronas NJ. Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. Implications for diagnosis and treatment. J Neurosurg 1994;80(1):3-15doi: 10.3171/jns.1994.80.1.0003.
18. Sekula Jr RF, Arnone GD, Crocker C, Aziz KM, Alperin N. The pathogenesis of Chiari I malformation and syringomyelia. Neurol Res 2011;33(3):232-9
19. Holly LT, Batzdorf U. Chiari malformation and syringomyelia. The pathogenesis of Chiari I malformation and syringomyelia.J Neurosurg Spine2019;(31):619–628.
20. Arnautovic A, Splavski B, Boop FA, Arnautovic KI: Pediatric and adult Chiari malformation Type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes. J NeurosurgPediatr2015;(15):161–177.
21. Gardner WJ, Angel J: The mechanism of syringomyelia and its surgical correction. Clin Neurosurg1958;(6):131–140.
22. Sadler B, Kuensting T, Strahle J, Sung Park T, Smyth M, Limbrick D.D, Dobbs M.B, Haller G, Gurnett C.A. Prevalence and Impact of Underlying Diagnosis and Comorbidities on Chiari 1 Malformation. Pediatr Neurol 2020;(106):32-37 doi: 10.1016/j.pediatrneurol.2019.12.005.
23. Urbizu A, Toma C, Poca MA, Sahuquillo J, Cuenca-Leon E, Cormand B, and Macaya A. Chiari malformation type I: a case-control association study of 58 developmental genes. PLoS One 2013;(8), e57241.
24. Strahle J, Muraszko KM, Kapurch J, Bapuraj JR, Garton HJ, Maher CO. Chiari malformation Type I and syrinx in children undergoing magnetic resonance imaging. J NeurosurgPediatr 2011;(8):205–213.
25. Kelly MP, Guillaume TJ, and Lenke LG. Spinal Deformity Associated with Chiari Malformation. Neurosurg Clin N Am 2015;(26):579–585.
26. Loukas M, Shayota BJ, Oelhafen K, Miller JH, Chern JJ, Tubbs RS, Oakes WJ. Associated disorders of Chiari Type I malformations: a review. Neurosurg Focus 2011;(31), E3.
27. Davidson L, Phan T.N, Myseros J.S, Magge S.N, Oluigbo C, Sanchez C.E, Keating R.F. Long-term outcomes for children with an incidentally discovered Chiari malformation type 1: what is the clinical significance? Childs Nerv Syst 2021;37(4):1191-1197.
28. Albert GW. Chiari Malformation in Children. Pediatr Clin North Am. 2021 ;68(4):783-792. doi: 10.1016/j.pcl.2021.04.015.
29. Milhorat TH, Capocelli AL Jr, Anzil AP, Kotzen RM, Milhorat RH: Pathological basis of spinal cord cavitation in syringomyelia: analysis of 105 autopsy cases. J Neurosurg1995;(82):802–812.
30. Bilston LE, Stoodley MA, Fletcher DF: The influence of the relative timing of arterial and subarachnoid space pulse waves on spinal perivascular cerebrospinal fluid flow as a possible factor in syrinx development. J Neurosurg2010;(112):808–813.
31. Stoodley MA, Brown SA, Brown CJ, Jones NR: Arterial pulsation-dependent perivascular cerebrospinal fluid flow into the central canal in the sheep spinal cord. J Neurosurg1997;(86):686–693.
32. Chatterjee S, Shivhare P, Verma SG. Chiari malformation and atlantoaxial instability: problems of co-existence. Childs Nerv Syst 2019;35(10):1755-1761 doi: 10.1007/s00381-019-04284-z.
33. Levy WJ, Mason L, Hahn JF. Chiari malformation presenting in adults: a surgical experience in 127 cases. Neurosurgery 1983;(12):377–390.
34. Dyste GN, Menezes AH, VanGilder JC. Symptomatic Chiari malformations. J Neurosurg1989;(71):159–168.
35. Menezes AH. Primary craniovertebral anomalies and the hindbrain herniation syndrome (Chiari I): data base analysis. PediatrNeurosurg1995;(23):260–269.
36. Menezes AH, Greenlee JDW, Donovan KA. Honored guest presentation: lifetime experiences and where we are going: Chiari I with syringohydromyelia–controversies and development of decision trees. Clin Neurosurg 2005;(52):297–305.
37. Aboulezz AO, Sartor K, Geyer CA, Gado MH. Position of cerebellar tonsils in the normal population and in patients with Chiari malformation: a quantitative approach with MR imaging. J Comput Assist Tomogr 1985;9(6):1033–6.
38. Barkovich AJ, Wippold FJ, Sherman JL, Citrin CM. Significance of cerebellar tonsillar position on MR. Am J Neuroradiol1986;7(5):795–9.
39. McClugage SG, Oakes WJ. The Chiari I malformation. J NeurosurgPediatr 2019;(1);24(3):217-226. doi: 10.3171/2019.5. PEDS18382.
40. Battal B, Kocaoglu M, Bulakbasi N, Husmen G, Sanal TH, Tayfun C: Cerebrospinal fluid flow imaging by using phase-contrast MR technique. Br J Radiol2011;(84):758–765.
41. Armonda RA, Citrin CM, Foley KT, Ellenbogen RG: Quantitative cine-mode magnetic resonance imaging of Chiari I malformations: an analysis of cerebrospinal fluid dynamics. Neurosurgery 1994;(35):214–224.
42. McGirt MJ, Nimjee SM, Fuchs HE, George TM: Relationship of cine phase-contrast magnetic resonance imaging with outcome after decompression for Chiari I malformations. Neurosurgery 2006;(59):140–146.
43. J Meadows J, Kraut M, Guarnieri M, Haroun RI, Carson BS. Asymptomatic Chiari Type I malformations identified on magnetic resonance imaging. J Neurosurg 2000;92(6):920-6. doi: 10.3171/jns.2000.92.6.0920.
44. Brockmeyer DL, Spader HS. Complex Chiari Malformations in children: Diagnosis and management. Neurosurgery Clinics of North America 2015;(26)(4)ː555-560.
45. Grabb PA, Mapstone TB, Oakes WJ. Ventral brain stem compression in pediatric and young adult patients with Chiari I malformations. Neurosurgery 1999;44(3):520–7 [discussion: 527–8].
46. Bollo RJ, Riva-Cambrin J, Brockmeyer MM, Brockmeyer DL. Complex Chiari malformations in children: an analysis of preoperative risk factors for occipitocervical fusion. J NeurosurgPediatr 2012;10(2):134–41.
47. Atchley T.J, Elizabeth N, Alford E.N, Rocque B.G. Systematic review and meta-analysis of imaging characteristics in Chiari I malformation: does anything really matter? Childs Nerv Syst 2020;36(3):525-534.
48. Ebenius B. The roentgen appearance in four cases of basilar impression. Acta Radiol (Stockolm)1934;(15):652–6.
49. Russell DS. Observations on the pathology of hydrocephalus. MRC Special Report No. 265. London: Her Majesty’s Stationery Office; 1949. 4th impression 1968.
50. Baker WC. Infantile hydrocephalus. Some clinical and pathological aspects. II. Pathological aspects. East Afr Med J. 1963;(40):544–51.
51. Tubbs RS, McGirt MJ, Oakes W.J. Surgical experience in 130 pediatric patients with Chiari I malformations. J Neurosurg2003;(99):291–296
52. Goel A. Is atlantoaxial instability the cause of Chiari malformation? Outcome analysis of 65 patients treated by atlantoaxial fixation. J Neurosurg Spine 2015;22(2):116–27.
53. Haddad F.A, Qaisi I, Joudeh N, Dajani H, Jumah F, Elmashala A, Adeeb N, Chern J.J, Tubbs RS. The newer classifications of the chiari malformations with clarifications: An anatomical review. Clin Anat 2018;31(3):314-322. doi: 10.1002/ca.23051. Epub 2018 Feb 20.
54. Iskandar BJ, Hedlund GL, Grabb PA, Oakes WJ. The resolution of syringohydromyelia without hindbrain herniation after posterior fossa decompression. J Neurosurg1998;(89):212-216.
55. Kyoshima K, Kuroyanagi T, Oya F, Kamijo Y, El-Noamany H, Kobayashi S. Syringomyelia without hindbrain herniation: tight cisterna magna. Report of four cases and a review of the literature. J Neurosurg2002;(96):239-249.
56. Newton EJ. Syringomyelia as a manifestation of defective fourth ventricular drainage. Ann R Coll Surg Engl1969;(44):194-213.
57. Tubbs RS, Elton S, Grabb P, Dockery SE, Bartolucci AA, Oakes WJ. Analysis of the posterior fossa in children with the Chiari 0 malformation. Neurosurgery 2001;(48):1050-1054; discussion 1054-1055.
58. Chern JJ, Gordon AJ, Mortazavi MM, Tubbs RS, Oakes WJ. 2011. Pediatric Chiari malformation Type 0: a 12-year institutional experience. J NeurosurgPediatr2011;(8):1-5.
59. Isik N, Elmaci I, Kaksi M, Gokben B, Isik N, Celik M. A new entity: Chiari zero malformation and its surgical method. Turk Neurosurg2011;(21):264-268.
60. Sekula RF, Jr., Jannetta PJ, Casey KF, Marchan EM, Sekula LK, McCrady CS. Dimensions of the posterior fossa in patients symptomatic for Chiari I malformation but without cerebellar tonsillar descent. Cerebrospinal Fluid Res 2005;(2):11.
61. Capra V, De Marco P, Merello E, Baffico AM, Baldi M, Divizia MT, Gimelli S, Mallet D, Raso A, Mascelli S, Toma P, Rossi A, Pavanello M, Cama A, Magnani C. Craniosynostosis, hydrocephalus, Chiari I malformation and radioulnar synostosis: probably a new syndrome. Eur J Med Genet 2009;(52):17-22.
62. Tubbs RS, Iskandar BJ, Bartolucci AA, Oakes WJ. A critical analysis of the Chiari 1.5 malformation. J Neurosurg2004;(101):179-183.
63. Deng X, Yang C, Gan J, Yang B, Wu L, Yang T, Xu Y. Chiari malformation type 1.5 in male monozygotic twins: case report and literature review. Clin Neurol Neurosurg2015;(130):155-158.
64. Kim IK, Wang KC, Kim IO, Cho BK. Chiari 1.5 malformation: an advanced form of Chiari I malformation. J Korean Neurosurg Soc 2010;(48):375-379.
65. Cesmebasi A, Loukas M, Hogan E, Kralovic S, Tubbs RS, Cohen-Gadol AA. The Chiari malformations: a review with emphasis on anatomical traits. Clin Anat2015;(28):184-194.
66. Scott WW, Fearon JA, Swift DM, Sacco DJ. Suboccipital decompression during posterior cranial vault remodeling for selected cases of Chiari malformations associated with craniosynostosis. J NeurosurgPediatr2013;(12):166-170.
67. Ömer N. Kisi MO, YurdalGezercan, Tahsin Erman. 2014. Chiari Malformation Type 1.5-related syringomyelia: treatment options differentiate this new entity from classic tonsillar ectopia: case report. Neurosurgery Quarterly 2014;(24):183-185.
68. Talamonti G, Marcati E, Mastino L, Meccariello G, Picano M, D'Aliberti G. Surgicalmanagement of Chiari malformation type II. Childs Nerv Syst 2020;36(8):1621-1634.
69. Kim I, Hopson B, Aban I, Rizk EB, Dias MS, Bowman R, Ackerman LL, Partington MD, Castillo H, Castillo J, Peterson PR, Blount JP, Rocque BG. Decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry. J NeurosurgPediatr 2018;(22):652–658.
70. McDowell MM, Blatt JE, Deibert CP, Zwagerman NT, Tempel ZJ, Greene S. Predictors of mortality in children with myelomeningocele and symptomatic Chiari type II malformation. J NeurosurgPediatr 2018;(21):587–596.
71. Talamonti G, D’Aliberti G, Collice M. Myelomeningocele: long-term neurosurgical treatment and follow-up in 202 patients. J Neurosurg 2007;(107) (5 Suppl Pediatrics):368–386.
72. Protzenko T, Bellas A, Pousa MS, Protzenko M, Fontes JM, de Lima Silveira AM, Sá CA, Pereira JP, ManganelliSalomão RM, Salomão JF, dos Santos Gomes SC. Reviewing the prognostic factors in myelomeningocele. Neurosurg Focus 2019;(47) (4):E2.
73. Gilbert JN, Jones KL, Rorke LB, Chernoff GF, James HE. Central nervous system anomalies associated with meningomyelocele, hydrocephalus, and the Arnold-Chiari malformation: reappraisal of theories regarding the pathogenesis of posterior neural tube closure defects. Neurosurgery 1986;(18):559–564.
74. Vandertop WP, Asai A, Hoffman HJ, Drake JM, Humphreys RP, Rutka JT, Decker LE. Surgical decompression for symptomatic Chiari II malformation in neonates with myelomeningocele. J Neurosurg 1992;(77):541–544.
75. Alford EN, Hopson BD, Safyanov F, Arynchyna A, Bollo RJ, Hankinson TC, Rocque BG, Blount JP. Care management and contemporary challenges in spina: a practice preference survey of the American Society of Pediatric Neurosurgery. J NeurosurgPediatr 2019;(24):548.
76. Stevenson K. Chiari type II malformation: past, present, and future. Neurosurg Focus 2004;(16) (E5):1–7.
77. Sacco D, Scott RM. Reoperation for Chiari malformations. PediatrNeurosurg 2003;(39):171–178.
78. Cakirer S. Chiari III malformation: varieties of MRI appearances in two patients. Clin Imaging 2003;(27):1-4.
79. Muscatello G. Ueber die angeborenenSpalten des Schädels und der Wirbelsäule. Archiv fkiln Chir Bd 1894;(47):162-301.
80. Fisahn C, Shoja MM, Turgut M, Oskouian RJ, Oakes WJ, Tubbs RS. The Chiari 3.5 malformation: a review of the only reported case. Childs Nerv Syst 2016;(32):2317-2319.
81. Ivashchuk G, Loukas M, Blount JP, Tubbs RS, Oakes WJ. Chiari III malformation: a comprehensive review of this enigmatic anomaly. Childs Nerv Syst 2015;(31):2035-2040.
82. Birinyi PV, Bieser S, Reis M, Guzman MA, Agarwal A, Abdel-Baki MS, Elbabaa SK. Impact of DTI tractography on surgical planning for resection of a pediatric pre-pontine neurenteric cyst: a case discussion and literature review. Childs Nerv Syst 2015;(31):457-463.
83. Chiari H. Überveränderungen des kleinhirns, des pons und der medulla oblongata infolge von congenitalerhydrocephalie des grosshirns. Nature 1895;(63):71-116.
84. Bayer. Zur Technik der Operation der Spina bifida und Encephalocele.Prag med Woch1892;(4):346.
85. Poretti A, Boltshauser E, Huisman TA. Chiari Malformations and Syringohydromyelia in Children. Semin Ultrasound CT MR 2016;(37):129-142.
86. Tekin D US, Iyigun O. Primary cerebellar agenesis- Chiari IV malformation. OMU Tip Derg2002;(19):213-216.
87. Morgenstern P.F, Tosi U, Cardenas R.U, Greenfield J.P. Ventrolateral Tonsillar Position Defines Novel Chiari 0.5 Classification. World Neurosurg2020;(136):444-453.
88. Arnautovic A, Splavski B, Boop FA, Arnautovic KI. Pediatric and adult Chiari malformation type I surgical series 1965-2013: a review of demographics, operative treatment, and outcomes. J NeurosurgPediatr 2015;(15):161-177.
89. Kennedy BC, Kelly KM, Phan MQ, et al. Outcomes after suboccipital decompression without dural opening in children with Chiari malformation type I. J NeurosurgPediatr 2015;(16):150-158.
90. Tubbs RS, Beckman J, Naftel RP, et al. Institutional experience with 500 cases of surgically treated pediatric Chiari malformation Type I. J NeurosurgPediatr 2011;(7):248-256.
91. Durham SR, Fjeld-Olenec K. Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I in pediatric patients: a metaanalysis. J NeurosurgPediatr 2008;(2):42-49.
92. Caldarelli M, Novegno F, Vassimi L, Romani R, Tamburrini G, Di Rocco C. The role of limited posterior fossa craniectomy in the surgical treatment of Chiari malformation type I: experience with a pediatric series. J Neurosurg 2007;106(3 Suppl):187-195.
93. Galarza M, Sood S, Ham S. Relevance of surgical strategies for the management of pediatric Chiari type I malformation. Child Nerv Syst 2007;(23): 691-696.
94. Tubbs RS, McGirt MJ, Oakes WJ. Surgical experience in 130 pediatric patients with Chiari I malformations. J Neurosurg 2003;(99):291-296.
95. Lee A, Yarbrough CK, Greenberg JK, Barber J, Limbrick DD, Smyth MD. Comparison of posterior fossa decompression with or without duraplasty in children with Type I Chiari malformation. Child Nerv Syst 2014;(30):1419-1424.
96. Pomeraniec IJ, Ksendzovsky A, Awad AJ, Fezeu F, Jane JA Jr. Natural and surgical history of Chiari malformation type I in the pediatric population. J NeurosurgPediatr 2016;(17):343-352.
97. Strahle J, Muraszko KM, Kapurch J, Bapuraj JR, Garton HJ, Maher CO. Chiari malformation type I and syrinx in children undergoing magnetic resonance imaging. J NeurosurgPediatr2011;(8):205-213.
98. Massimi L, Caldarelli M, Frassanito P, Di Rocco C. Natural history of Chiari type I malformation in children. Neurol Sci 2011;(32) (Suppl 3): S275-S277.
99. Strahle J, Muraszko KM, Kapurch J, Bapuraj JR, Garton HJ, Maher CO. Natural history of Chiari malformation type I following decision for conservative treatment. J NeurosurgPediatr2011;(8):214-221.
100. Novegno F, Caldarelli M, Massa A, Chieffo D, Massimi L, Pettorini B, Tamburrini G, Di Rocco C. The natural history of the Chiari type I anomaly. J NeurosurgPediatr 2008;(2):179-187.
101. Gagnadoux F, Meslier N, Svab I, Menei P, Racineux JL. Sleep-disordered breathing in patients with Chiari malformation: improvement after surgery. Neurology 2006;(66):136-138.
102. Liu C, Ulualp SO. Type I Chiari malformation presenting with laryngomalacia and dysphagia. Pediatr Int 2015;(57):795-797.
103. Addo NK, Javadpour S, Kandasamy J, Sillifant P, May P, Sinha A. Central sleep apnea and associated Chiari malformation in children with syndromic craniosynostosis: treatment and outcome data from a supraregional national craniofacial center. J NeurosurgPediatr 2013;(11):296-301.
104. Dhamija R, Wetjen NM, Slocumb NL, Mandrekar J, Kotagal S. The role of nocturnal polysomnography in assessing children with Chiari type I malformation. Clin Neurol Neurosurg2013;(115):1837-1841.
105. Langridge B, Phillips E, Choi D. Chiari malformation type 1: a systematic review of natural history and conservative management. World Neurosurg2017;(104):213-219.
106. Curone M, Valentini LG, Vetrano I, Beretta E, Furlanetto M, Chiapparini L, Erbetta A, Bussone G. Chiari malformation type 1-related headache: the importance of a multidisciplinary study. Neurol Sci 2017;(38) (Suppl 1):91-93.
107. Beretta E, Vetrano IG, Curone M, Chiapparini L, Furlanetto M, Bussone G,Valentini L.G. Chiari malformation-related headache: outcome after surgical treatment. Neurol Sci 2017;(38) (Suppl 1): 95-98.
108. Kalb S, Perez-Orribo L, Mahan M, Theodore N, Nakaji P, Bristol RE. Evaluation of operative procedures for symptomatic outcome after decompression surgery for Chiari type I malformation. J Clin Neurosci 2012;(19):1268-1272.
109. Chen J, Li Y, Wang T, Gao J, Xu J, Lai R, Tan D. Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I in adult patients. Medicine 2017;(96): e5945.
110. Klekamp J. Surgical treatment of Chiari I malformation--analysis of intraoperative findings, complications, and outcome for 371 foramen magnum decompressions. Neurosurgery 2012;71(2):365-80; discussion 380.
111. Zhao JL, Li MH, Wang CL, Meng W. A Systematic Review of Chiari I Malformation: Techniques and Outcomes. World Neurosurg 2016;(88):7-14.
112. Frič R, Eide PK. Chiari type 1-a malformation or a syndrome? A critical review. Acta Neurochir (Wien). 2020;162(7):1513-1525.
113. Tubbs RS, Demerdash A, Vahedi P, Griessenauer CJ, Oakes WJ. Chiari IV malformation: correcting an over one century long historical error. Childs Nerv Syst 2016; 32(7):1175–1179.
114. Liu W, Wu H, Aikebaier Y, Wulabieke M, Paerhati R, Yang X. No significant difference between chiari malformation type 1.5 and type I. Clin Neurol Neurosurg 2017;(157):34-39.
115. liff JJ, Nedergaard M. Is there a cerebral lymphatic system? Stroke 2013;(44)(6 Suppl 1): S93–S95.
116. Iliff JJ, Wang M, Liao Y, Plogg BA, Peng W, Gundersen GA, Benveniste H, Vates GE, Deane R, Goldman SA, Nagelhus EA, Nedergaard M. Sci Transl Med 2012;(15);4(147):147ra111.
117. Eide PK, Vatnehol SAS, Emblem KE, Ringstad G. Magnetic resonance imaging provides evidence of glymphatic drainage from human brain to cervical lymph nodes. Sci Rep 2018(8);8(1):7194.
118. Ringstad G, Vatnehol SAS, Eide PK. Glymphatic MRI in idiopathic normal pressure hydrocephalus. Brain 2017;(1);140(10):2691-2705.