In cases where other therapies for Chiari malformation (CM) are not successful and the patient has either unbearable pain or consistent nervous system issues, surgical decompression may be needed.

An incision at the back of the neck allows the surgeon access to the base of the skull and the upper vertebrae. A bone and two vertebrae are removed, the spinal cord covering is cut and a patch is sewn in that allows for the free flow of spinal fluid. The procedure releases pressure on the spinal cord caused by the Chiari malformation, which provides relief to the patient.