Stability and motion: addressing the pathology of Chiari malformation and craniocervical junction

P hysiology of the craniocervical/cervicomedullary region requires at once stability and motion. Alterations in biomechanical and hydrodynamic properties may result in central nervous system pathology with profound impact on neurological function and quality of life. Chiari type I malformation, syringomyelia, and basilar invagination, for example, are discrete clinical entities that frequently occur as a cohort and may be relentlessly progressive. In recent years, advances in dynamic high-resolution imaging and detailed phenotyping, coupled with surgical innovation and aggregated clinical experience, have enabled substantial advances in the treatment of these conditions.