Chiari malformation (CM) is a severe malformation of the craniovertebral region and a congenital pathology of the formation of the rhomboid brain, which manifests itself the as the form of a mismatch between the sizes of the posterior cranial fossa and the brain structures located in this region [1, 2].
In clinical practice, one of the main methods of treating the imbalance between the volume of neural formations and the capacity of the posterior cranial fossa is surgical intervention aimed to equalize the hydrodynamic pressure of the cerebrospinal fluid at the craniospinal junction, create a large occipital cistern and eliminate compression of the brain stem [3, 4].
In pediatric practice, in order to free the bulbo-medullary part of the brain and restore liquorodynamics, they perform minimally invasive decompression of the craniovertebral duraplasty transition and resection of the arch of the first vertebra. In adulthood, it is preferable to perform large-scale intra-arachnoid dissection, supplemented by coagulation and resection of the cerebellar tonsils (СT).
Minimally invasive interventions at children’s age is more advantageous because of a low risk of postoperative complications, but the higher frequency of long-term reoperations due to the ineffectiveness of the first intervention (13 % on average) , as well as the low percentage of regression of the manifestation of the main CM outcome, syringomyelia, is the price of safety .
Moreover, as a result of fragmentary elimination of the compressing factor during minimally invasive techniques, the incidence of headaches and suboccipital pains in the postoperative period during exercise is increased.
It is believed that headaches during active movements of the cervical spine are associated with sudden episodes of increased intracranial pressure . According to J. Edmeads (1988), suboccipital headaches are caused by compression of C1-C2 roots by caudally displaced cerebellar tonsils .