Biportal endoscopic foramen magnum decompression and C1 posterior arch resection for Chiari malformation type I: Technical note.
4 affiliations
- 1Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional de Occidente, Guadalajara, Mexico.
- 2Department of Orthopedics and Traumatology, Hospital de Especialidades, Centro Médico Nacional de Occidente, Guadalajara, Mexico.
- 3Department of Neurosurgery, Hospital Regional de León, Institute for Social Security and Services for State Workers, Guanajuato, Mexico.
- 4Department of Neurosurgery, Hospital San José, Celaya, Mexico.
Abstract
Background
Chiari malformation type I is commonly treated with posterior fossa decompression and C1 posterior arch resection to restore cerebrospinal fluid flow at the craniocervical junction. Although open microsurgical decompression remains the standard approach, minimally invasive techniques may reduce soft-tissue disruption and postoperative morbidity. Biportal endoscopy may provide adequate visualization and instrument maneuverability at the craniocervical junction.Methods
A 60-year-old female presented with a 2-year history of progressive Valsalva-induced occipital headache and bilateral upper-limb paresthesias. Magnetic resonance imaging demonstrated a 5.7 mm descent of the cerebellar tonsils without syringomyelia. The patient underwent biportal endoscopic suboccipital decompression and partial C1 posterior arch resection using a 30° endoscope, high-speed burrs, Kerrison rongeurs, radiofrequency, and continuous saline irrigation. No dural opening or duraplasty was performed.Results
The operative time was 135 min, with minimal blood loss and no intraoperative complications. Postoperative CT confirmed adequate osseous decompression, including a 21 × 22 mm suboccipital craniectomy and a 10 mm C1 posterior arch resection. Postoperatively, the patient improved clinically without complications and was discharged on postoperative day 2.Conclusion
Biportal endoscopic foramen magnum decompression with C1 posterior arch resection appears feasible in selected adult patients with Chiari malformation type I.
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BibTeX
@article{tiradoornelas2026biportal,
title = {{Biportal endoscopic foramen magnum decompression and C1 posterior arch resection for Chiari malformation type I: Technical note.}},
author = {Héctor Alonso Tirado-Ornelas and Silvia Loretto Tirado-Ornelas and Alejandro Esparza-Guinea and Yessenia Argentina RojasPérez and Jassiel Rosario Gastelum-Moreno and Rodolfo Guerrero-Pérez},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_877_2026},
url = {https://europepmc.org/article/MED/42974253},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Biportal endoscopic foramen magnum decompression and C1 posterior arch resection for Chiari malformation type I: Technical note.
AU - Héctor Alonso Tirado-Ornelas
AU - Silvia Loretto Tirado-Ornelas
AU - Alejandro Esparza-Guinea
AU - Yessenia Argentina RojasPérez
AU - Jassiel Rosario Gastelum-Moreno
AU - Rodolfo Guerrero-Pérez
PY - 2026
DA - 2026/10/02
JO - Surgical neurology international
DO - 10.25259/sni_877_2026
UR - https://europepmc.org/article/MED/42974253
AB - Background Chiari malformation type I is commonly treated with posterior fossa decompression and C1 posterior arch resection to restore cerebrospinal fluid flow at the craniocervical junction. Although open microsurgical decompression remains the standard approach, minimally invasive techniques may reduce soft-tissue disruption and postoperative morbidity. Biportal endoscopy may provide adequate visualization and instrument maneuverability at the craniocervical junction.Methods A 60-year-old female presented with a 2-year history of progressive Valsalva-induced occipital headache and bilateral upper-limb paresthesias. Magnetic resonance imaging demonstrated a 5.7 mm descent of the cerebellar tonsils without syringomyelia. The patient underwent biportal endoscopic suboccipital decompression and partial C1 posterior arch resection using a 30° endoscope, high-speed burrs, Kerrison rongeurs, radiofrequency, and continuous saline irrigation. No dural opening or duraplasty was performed.Results The operative time was 135 min, with minimal blood loss and no intraoperative complications. Postoperative CT confirmed adequate osseous decompression, including a 21 × 22 mm suboccipital craniectomy and a 10 mm C1 posterior arch resection. Postoperatively, the patient improved clinically without complications and was discharged on postoperative day 2.Conclusion Biportal endoscopic foramen magnum decompression with C1 posterior arch resection appears feasible in selected adult patients with Chiari malformation type I.
SN - 2229-5097
SN - 2152-7806
ER -