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Help share more videos like this by donating to Bobby Jones CSF: https://bobbyjonescsf.org/donate-online/ This lecture from Dr. Brandon Rocque explains the basics of Chiari I malformation and syringomyelia, focusing on the anatomy, diagnosis, symptoms, and when surgery may be appropriate. Chiari I is often identified on MRI using a commonly used threshold of 5 millimeters of tonsillar descent, though Dr. Rocque emphasizes that this cutoff is somewhat arbitrary. Because of this variability, clinical symptoms—rather than imaging alone—are crucial in determining whether treatment is necessary. Symptoms associated with Chiari I, include characteristic cough-induced headaches at the back of the head, neurological symptoms related to syringomyelia, and possible links to sleep apnea. Surgical treatment, known as posterior fossa decompression, aims to enlarge the opening at the base of the skull to restore normal fluid flow and relieve pressure. Rocque highlights ongoing debates in neurosurgery about which patients truly benefit from surgery, ongoing research projects such as the Chiari Surgical Success Scale, Common Data Elements for Chiari, as well as how to know which research papers are sharing useful results, transition of care for pediatric patients, and other questions from the patient and caregiver audience. This lecture was presented at Children's of Alabama in January (2026). Connect with Us: Facebook: Facebook.com/bobbyjonescsf Twitter: Twitter.com/bobbyjonescsf Instagram: http://instagram/bobbyjonescsf