Preface| Volume 34, ISSUE 1, Pxv, January 2023

Advances in the Field of Chiari I Malformation and Integrating Them into Clinical Practice

      The field of Chiari type 1 malformation (CM-1) presents an interesting contrast between the past and the future. The diagnosis itself is steeped in history and irrevocably tied to the initial classification schema described by Hans Chiari in 1891. Meanwhile, leading-edge work in genetics, dynamic imaging, patient-oriented research, and other advances is driving the future of the field. This issue of Neurosurgery Clinics of North America, entitled “Chiari I Malformation,” reconciles the vast chasm between past and future of this commonly encountered disorder.
      Far more than simply an update of the previous issue on this topic in 2015, “Chiari I Malformation” addresses head-on the nosology of CM-1 and the intersection of epidemiology and disparities in care among disadvantaged groups. In addition to expert reviews of clinical features and current and emerging radiologic tools, the articles contained herein consider next-level complexity in the management of CM-1, including ventral brainstem compression, craniovertebral junction instability, and spinal deformity. Emerging strategies to evaluate and treat comorbid idiopathic intracranial hypertension and cerebrospinal fluid (CSF) leaks are also discussed.
      This issue of Neurosurgery Clinics of North America also provides a state-of-the-field analysis of the pathophysiology of CM-1, from the genetic basis of CM-1 and its relationship to various comorbidities to CSF hydrodynamics and pulsatility. Notably, controversies regarding the management of dysautonomia and postural intolerance and the putative role of heritable disorders of connective tissue are discussed in detail by true content experts.
      We would like to conclude by thanking each of the contributing authors for sharing their accumulated knowledge, experience, and wisdom. This work is built on the shoulders of giants, such as Ed Oldfield, and we hope that you find this collection valuable as you build expertise in this complex disease and its contemporary management.