J Neurosurg Spine 43:237–245, 2025
This retrospective study compared suboccipital craniectomy and cranioplasty for foramen magnum decompression in adult Chiari malformation. Both techniques improved symptoms and syrinx size, but cranioplasty incurred higher costs without significant clinical or radiological advantages. Cost considerations should be discussed during shared decision-making.
• Suboccipital craniectomy and suboccipital cranioplasty are two surgical techniques for foramen magnum decompression (FMD) in adult Chiari malformation.
• Both procedures significantly improve preoperative symptoms and reduce syrinx size, with no significant difference in clinical outcomes.
• Suboccipital craniectomy results in a greater increase in subarachnoid space compared to cranioplasty.
• No significant differences were found in surgical time, estimated blood loss, or cervical alignment between the two groups.
• Suboccipital cranioplasty incurs higher daily medical costs due to the use of plates and screws for bony reconstruction.
• Both techniques have similar rates of complications and secondary surgeries.
• The additional costs of cranioplasty should be discussed with patients during shared decision-making.
• Study limitations include retrospective design, small sample size, surgeon preference, and shorter follow-up for cranioplasty.
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