J Neurosurg 143:4–12, 2025
This prospective study found that patients with Chiari malformation type I commonly experience cognitive and psychiatric impairments, particularly in executive function and visuospatial memory. Following posterior fossa decompression surgery, 89% showed significant improvement in cognitive and/or psychiatric symptoms, highlighting the cerebellum’s role in these functions.
• Chiari malformation type I (CM-I) patients often have unrecognized cognitive and psychiatric symptoms, including deficits in executive function, visuospatial memory, and increased depression, anxiety, and related symptoms.
• This prospective study assessed 54 CM-I patients with cognitive or psychiatric complaints before and after posterior fossa decompression (PFD) surgery.
• Preoperatively, patients performed worse than normative samples in executive function and visuospatial memory, and reported more psychiatric symptoms across all measured domains.
• Six months after surgery, 89% of patients showed clinically significant improvements (>1 SD) in cognitive and/or psychiatric domains.
• Improvements were most notable in visuospatial memory and psychiatric symptoms such as depression and anxiety, which normalized to levels seen in the general population.
• Patients with the most severe preoperative deficits experienced the greatest postoperative improvements.
• The findings support a key role for the cerebellum in cognitive and psychiatric dysfunction and suggest that some symptoms in CM-I are potentially treatable with targeted cerebellar intervention.
• Limitations include lack of a control group and focus on symptomatic, self-reporting patients, so results may not generalize to all CM-I cases.
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