Our Approach

01 What This Clinic Is, and Is Not

One surgeon. No institution. No predetermined outcome.

Chiari Clinic is a specialized neurosurgical program of Cerbo Clinic, an independent neurosurgery practice serving the Peninsula and Bay Area. There is one surgeon. There is no institution behind the name, no committee, no marketing department deciding how to present neurosurgery to you. What you encounter here is the clinical thinking of a single board-certified neurosurgeon who has chosen to focus significantly on adult Chiari malformation — because it is a condition that, more than almost any other in neurosurgery, suffers from being managed without adequate expertise.

That focus is not a marketing claim. It is a consequence of a specific observation: the majority of adults with a Chiari diagnosis are either undertreated — managed with a "watch and wait" that has no real structure behind it — or referred to large institutional programs where wait times are long, access is difficult, and the relationship with the surgeon is thin. The independent, accessible, subspecialty-focused practice does not currently exist in this space in the Bay Area. This clinic exists because it should.

02 The Clinical Philosophy

When surgery is — and is not — the answer

The most important thing this clinic believes about Chiari surgery is that it is indicated for a minority of people diagnosed with Chiari malformation — and that determining whether you are in that minority requires genuine clinical evaluation, not a reflexive response to a radiology report.

This principle is drawn from the 2022 international consensus document on Chiari and syringomyelia authored by 32 specialists from 10 countries — the governing document behind the clinical recommendations on this site and in this practice.

03 What a Consultation Involves

A directed clinical assessment — not a confirmation of the radiology report

A consultation at Cerbo Clinic for Chiari malformation begins before the appointment and ends with a complete, honest account of where you stand — not a scripted summary of the condition, and not a recommendation shaped by anything other than your clinical picture.

• 1

  Imaging review before you arrive

  Imaging is reviewed in detail before the appointment — not summarized from a report, but reviewed directly: the actual sequences, the morphology of the tonsils, the CSF spaces at the foramen magnum, the presence and characteristics of any syrinx, and the associated findings the radiology report may have mentioned in passing or missed entirely.

• 2

  Directed clinical history

  The history is taken with attention to the specific symptoms that carry diagnostic weight in Chiari: the character, location, and trigger pattern of headache; the presence and distribution of sensory changes; hand strength and fine motor function; balance and coordination; sleep quality and respiratory symptoms; and autonomic symptoms including orthostatic intolerance. This is not a general screen. It is a directed assessment for a specific structural problem.

• 3

  A Chiari-specific neurological examination

  The neurological examination covers what a Chiari assessment should cover: lower cranial nerve function, cerebellar signs, motor strength with attention to intrinsic hand muscles, sensory testing with separate evaluation of pinprick and temperature discrimination, fundoscopy for papilledema, and postural vital signs when indicated.

• 4

  A complete, honest assessment — without pressure

  At the conclusion, a clinical assessment is offered: an honest account of where you are, whether the imaging and clinical findings are anatomically consistent, what additional evaluation may be warranted, and what the appropriate management approach is for your specific situation. For many patients, that will not be surgery. For some it will be a structured observation plan. For a subset it will be a recommendation for surgical planning — with a detailed explanation of what the surgery involves, what it can realistically accomplish, and what it cannot. It will always be a complete assessment delivered without pressure toward any predetermined outcome.

04 Honest Assessment Over Surgical Volume

No institutional incentive to operate

Independent neurosurgical practice is not sustained by volume alone. A single-surgeon practice with a clinical focus on a condition that, for most patients, does not require surgery, is not a model that is motivated by maximizing the number of operations performed. It is motivated by being the consultation that was actually worth having.

05 The Training Context

Board certification, scope of practice, and where subspecialty focus matters

Within neurosurgery, Chiari malformation management — specifically posterior fossa decompression with duraplasty, the standard surgical treatment for symptomatic adult CM-I — is core to neurosurgical training and within the scope of a board-certified neurosurgeon's practice. It requires meticulous microsurgical technique, careful patient selection, and thorough preoperative planning.

The surgical decision in Chiari cases, however, is where subspecialty focus matters most. The cases that present cleanly — progressive neurological deficit, syrinx with documented progression, Valsalva-triggered headache unresponsive to medical management — are straightforward in their indication. The majority of Chiari patients presenting for consultation do not present cleanly. They present with mixed symptom pictures, borderline imaging, comorbid conditions that complicate attribution, and clinical histories that require careful interpretation. Managing that complexity well is not a volume question. It is an experience and judgment question.

The focus on adult Chiari at this practice, the commitment to taking the full clinical picture seriously rather than defaulting to operative or non-operative management by habit, and the independent practice structure that removes institutional pressures from clinical decision-making — these are the elements that define the approach here and differentiate it from the standard academic center experience.

06 The Relationship to Cerbo Clinic

All clinical care takes place through Cerbo Clinic Neurosurgery

Chiari Clinic is a specialized program of Cerbo Clinic Neurosurgery. All clinical care, surgical planning, and operative care takes place through Cerbo Clinic. Patients seen through chiariclinic.com are patients of Cerbo Clinic — with access to the full scope of neurosurgical services that entails, not only Chiari-related care.

Cerbo Clinic accepts most major insurance plans and offers prompt appointments. Referrals from neurologists, primary care physicians, and imaging centers are welcome. Patients may also self-refer directly.

Learn more about the practice, the surgeon, and the care model on the Cerbo Clinic About page (opens in new tab), or go directly to schedule a consultation (opens in new tab).