Est a procedure, which consists of a suboccipital craniectomy and a c1 (and occasionally c1 and c2) laminectomy, plus an extreme lateral foramen magnum opening, along with a y-shaped dural incision with preservation of the arachnoid membrane, and an expandable duraplasty [36, 42]. Their series included 44 patients with symptomatic cm-i. Fifteen patients had cm-i with associated syringomyelia (34%), while 29 patients (66%) had cm-i with no syringomyelia. Preoperatively, 37 patients (84. 1%) were functionally independent (of whom 13 had syringomyelia), while 7 patients (15. 9%) were functionally dependent (two of these with syringomyelia). There was no operative mortality, and surgery did not elicit any new neurological deficits. Postoperatively, all their patients were functionally independent. For those patients with isolated cm-i, the average postoperative karnofsky performance score was 90 versus 76 before surgery. For those patients with cm-i and syringomyelia, the average postoperative karnofsky score was 89 versus 74 before surgery. Additionally, they reported that syrinx size was postoperatively decreased in 60%, while in 40% it remained stable with no further increase. Their postoperative csf leakage was 4. buy cialis 10mg 5%, while their surgical wound infection rate was 11. 4%. They concluded that this type of craniocervical decompression achieved the best results with minimal complications and side effects [36, 42]. The surgical treatment of the chiari-associated syringomyelia and the selection of the most e.