Tonsillar resection (PFDRT)

What it is

Tonsillar resection — part of posterior fossa decompression with resection of tonsils (PFDRT) — is a surgical approach in which part of the cerebellar tonsils is removed (resected) during decompression. It is a more aggressive technique used in certain cases to maximize the opening and CSF flow.

Understanding Tonsillar resection (PFDRT)

When the goal is to maximally open the space at the craniocervical junction — for example, in cases with significant crowding or a syrinx — some surgeons remove a portion of the lower cerebellar tonsils, rather than only shrinking them. This PFDRT approach can effectively open the CSF outflow and is one of the techniques studied for Chiari with syringomyelia. However, because it involves removing tonsillar tissue within the CSF space, it is more aggressive and carries more risk than bony-only or arachnoid-sparing decompression. The decision to resect the tonsils is individualized, weighing the potential benefit (maximizing CSF flow) against the added risk. Understanding tonsillar resection clarifies a more aggressive option for opening the space in selected Chiari cases.

Why it matters

Understanding tonsillar resection helps families see a more aggressive surgical option — removing part of the tonsils — used in certain cases to maximize CSF flow, weighed against its greater risk.