© 2013 Springer Science+Business Media New York. All rights reserved. It was not until the late nineteenth century when reports of hindbrain herniation (Chiari malformations) began to be published. However, even earlier reports can be found in the extant literature. These include a report of hindbrain herniation in association with myelomeningocele by Tulp (1593-1674) in 1641. Cleland and Arnold would also report cases of hindbrain herniation found in patients with myelomeningoceles. Probably the first description of hindbrain herniation in the absence of myelodysplasia was made by Langhans in 1881. However, it was Chiari, 10 years later, who would classify and further our knowledge of these embryologic derailments. Penfield, Gardner, and Van Houweninge Graftdijk would each further our understanding of these malformations via surgical intervention. The evolution of surgery for hindbrain herniation is indebted to pioneers such as those described herein. Our current understanding and treatment of these embryological derailments are based on years of observation and surgical trial and error.