A benign Chiari I malformation (CM I) is one with minimal or no classical symptoms at presentation and no imaging evidence of syringomyelia, hydrocephalus, or spinal cord signal change. Published literature about this entity is limited and based primarily on retrospective cohort studies. Benign CM I likely represents about 40% of all CM I and has a favorable clinical course. In the available literature, rate of new syrinx development is about 2%, while 9% of patients worsen clinically, and 4% of patients require posterior fossa decompression. We recommend clinical and radiographic follow-up of patients with benign CM I.