Tonsillar herniation spectrum: more than just Chiari I. Update and controversies on classification and management

  • Pietro Fiaschi
  • Giovanni Morana
  • Pasquale AnaniaEmail author
  • Andrea Rossi
  • Alessandro Consales
  • Gianluca Piatelli
  • Armando Cama
  • Marco Pavanello


Cerebellar tonsil herniation comprises a spectrum of disorders sharing a common neuroimaging finding consisting of downward displacement of the cerebellar tonsils through the foramen magnum and into the upper cervical spinal canal. This not uncommon condition may result from a large host of congenital or acquired causes, and confusion regarding its classification and pathogenesis still exists. Terminology also remains heterogeneous, including inconsistencies in the usage of the “Chiari 1” monicker. In this paper, the hypothesized mechanisms of development of tonsillar herniation are reviewed and strategies of management are discussed, with particular attention to surgical options adapted to the underlying etiology. A focus will be placed on acquired causes of tonsillar herniation.


Tonsil Herniation Chiari Cerebellum Foramen magnum Pediatric 


Funding information

The authors declare that they did not receive funding for this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Giannina Gaslini Institute and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all the patients included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryIRCCS Ospedale Policlinico San MartinoGenovaItaly
  2. 2.Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI)Università di GenovaGenovaItaly
  3. 3.Neuroradiology UnitIRCCS Istituto Giannina GasliniGenovaItaly
  4. 4.Neurosurgery UnitOspedale Policlinico “San Martino”GenovaItaly
  5. 5.Division of NeurosurgeryIRCCS Istituto Giannina GasliniGenovaItaly

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