Under what circumstances do you consider duraplasty for Chiari 1 decompression?

I always place a duraplasty for Chiari 1 to increase the space around the tonsils and attempt to resume normal biphasic flow of CSF anteriorly and posteriorly.

There are many surgeons who use duraplasty for every Chiari decompression and that is understandable because it works so well. Recent studies even suggest that the complication profile is not significantly higher than doing a bone-only decompression.

There are other studies that suggest a bone-only ...