© 2013 Springer Science+Business Media New York. All rights reserved. Decompression of the craniocervical junction for the Chiari I malformation is a safe and effective procedure for appropriately selected patients. Postoperatively, associated syringes are likely to resolve and, if small, do not usually progress, and Valsalva-related occipital headaches are predicatively relieved immediately after surgery and do not recur. Serious surgical complications are rare. Although pathology is not usually identified, we believe that evaluation of the intradural contents is important in order to verify for intradural pathology (e.g., arachnoid webs) and to avoid continued symptoms and the necessity for reoperation. Avoiding subarachnoid blood and other subarachnoid irritants enhances recovery, and free cerebrospinal fluid egress from the fourth ventricular outlets is critical. Preoperative evaluation of potentially associated hydrocephalus and craniocervical instability is important.