Concierge neurosurgery · London
Cranio-cervical decompression, for Chiari I and syringomyelia.
A patient guide to posterior fossa decompression — when it is offered, how it is done, and the trade-offs between bony-only surgery, duraplasty and tonsillar reduction.
Why patients choose us
- 01
A skull-base and spine neurosurgeon
Not a generalist. A consultant who does cranio-cervical junction work as a routine part of their practice, in a hospital equipped for it.
- 02
The imaging read properly first
MRI of the brain and cervical spine plus a CSF flow (cine) study — reviewed alongside your symptoms before surgery is offered.
- 03
The less-invasive option considered
Bony-only decompression is on the table where it fits. Duraplasty and tonsillar reduction are reserved for the cases that need them.
Indicative pricing
What cranio-cervical decompression costs in London.
Indicative ranges across our partner neurosurgical units. We come back with firm figures once the imaging and plan are agreed.
In short
Decompression with duraplasty in our network: £13,000–£20,000, home in 3–5 nights.
| Procedure | Indicative range | Typical duration | Stay |
|---|---|---|---|
| Neurosurgical consultation | £300–£500 | 45 min | Same visit |
| MRI brain + cervical spine with CSF flow (cine) | £900–£1,600 | 60–75 min | 48 hours |
| Bony-only posterior fossa decompression | £10,000–£16,000 | 2–3 hr surgery | 2–4 nights |
| Decompression with duraplasty | £13,000–£20,000 | 3–4 hr surgery | 3–5 nights |
| Decompression with duraplasty + tonsillar reduction | £15,000–£24,000 | 4–5 hr surgery | 3–6 nights |
| Combined decompression + syringo-subarachnoid shunt | On quote | Case-dependent | Case-dependent |
Prices vary by hospital, by neurosurgeon, by the technique chosen, and by length of stay. Combined shunt procedures and complex revisions are quoted on a case-by-case basis.
The problem
The right imaging, the right neurosurgeon, the right technique.
Chiari-related surgery is under-imaged, over-generalised and — sometimes — done too soon. We do the imaging properly, get the right opinion, and pick the technique that actually matches the case.
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Incidental Chiari on MRI?
Not everyone with tonsillar descent needs surgery. Symptom scoring and a CSF flow study help decide.
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Symptomatic but unclear?
A structured neurosurgical review — with the imaging read alongside the story — sorts the picture out.
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Surgery on the table?
Bony-only, duraplasty, or with tonsillar reduction — each has trade-offs. We help you weigh them.
The journey
Imaging, decision, surgery, follow-up — in order.
One team from the first enquiry through to the post-operative MRI.
Phase 1 · Before surgery
Imaging, scoring, decision
Phase 2 · Surgery and inpatient care
Operating theatre and neuro ward
Phase 3 · Follow-up
Review and interval MRI
- 01
Before
You send us the symptoms and imaging
A short, confidential form. Headache pattern, neurological symptoms, any prior MRI or reports — all in one place.
- 02
Before
MRI and CSF flow study
Brain and cervical MRI with a cine (CSF flow) sequence. If you already have recent imaging, we review it; if not, we arrange it.
- 03
Before
Symptom scoring and neurosurgical review
A structured assessment of Chiari-related symptoms and any syrinx, reviewed by a consultant skull-base and spine neurosurgeon.
- 04
Before
A shared decision on surgery
Whether to operate, and — if so — bony-only, bony with duraplasty, or with tonsillar reduction. Written information, no rush.
- 05
Surgery
The procedure itself
Suboccipital craniectomy and C1 laminectomy under GA. Duraplasty and tonsillar work added where the plan calls for them.
- 06
Surgery
Immediate post-op care
Recovery in a monitored bed. Watched for CSF leak, pseudomeningocele, hydrocephalus and aseptic meningitis over the first days.
- 07
After
Follow-up and interval MRI
Wound and neurological review, then interval MRI to check decompression and, where relevant, syrinx response.
Typical end-to-end: 4–8 weeks from enquiry to surgery. Full recovery: 6–12 weeks.
When it helps
When cranio-cervical decompression is the right step.
The clinical pictures that most often lead to surgery — plus the red flag that needs same-day neurosurgical assessment.
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Symptomatic Chiari I malformation
Occipital or suboccipital headache made worse by coughing, sneezing or straining (Valsalva) — the classic pattern.
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Cervicomedullary compression
Imaging shows the brainstem or upper cord compressed at the foramen magnum with matching neurological signs.
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Syringomyelia
A fluid-filled cavity (syrinx) within the spinal cord, often with sensory loss, weakness or dissociated pain and temperature.
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Cerebellar dysfunction
Unsteadiness, poor coordination or gait disturbance attributable to cerebellar tonsillar herniation.
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Cranial nerve dysfunction
Lower cranial nerve signs — hoarseness, swallowing difficulty, tongue weakness or sleep-disordered breathing.
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Progressive myelopathy
Upper motor neuron signs, hand clumsiness or gait change from cord compression at the cranio-cervical junction.
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Failed conservative management
Disabling symptoms that have not responded to analgesia, activity change and neurological monitoring over time.
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Red flag: rapid neurological decline
New or fast-worsening weakness, swallowing failure or reduced consciousness needs same-day neurosurgical assessment.
Procedure options
Bony-only, duraplasty, or with tonsillar reduction.
What each option actually involves — and where in the decision tree it sits.
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Bony-only decompression
Suboccipital craniectomy and C1 laminectomy without opening the dura. Lower morbidity; often used first in selected cases.
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Decompression with duraplasty
Bony work plus opening the dura and enlarging it with a patch to increase CSF space at the foramen magnum.
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Duraplasty with autologous pericranium
The patient’s own pericranium as the dural patch — a natural graft with a good record for watertight closure.
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Duraplasty with cadaveric dura
Processed human dura where autologous tissue is unsuitable. Convenient handling and reliable closure.
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Duraplasty with a synthetic patch
A synthetic collagen or ePTFE patch when biological options are not appropriate. Sizing is standardised.
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Tonsillar reduction (cautery or resection)
Shrinking or partially resecting the cerebellar tonsils to reopen CSF flow — reserved for cases where duraplasty alone is unlikely to suffice.
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Combined syringo-subarachnoid shunt
A small shunt from the syrinx to the subarachnoid space where a persistent or growing cavity does not settle with decompression alone.
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Consultation only
A neurosurgical opinion on whether surgery is right at all, and — if so — which technique fits your imaging and symptoms.
Our vetted London network
A small panel of neurosurgeons, we picked them.
Consultant skull-base and spine neurosurgeons at hospitals equipped for cranio-cervical junction work. Introductions are made privately, once we understand the case.
Selection criteria
How we choose every neurosurgeon in our network.
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Consultant neurosurgeons with a skull-base and cranio-cervical practice
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Full imaging pathway — MRI brain, cervical spine and CSF flow (cine)
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Hospitals with neuro high-dependency and 24-hour on-call neurosurgery
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Multidisciplinary review with neurology and neuroradiology where useful
Safety and recovery
The risks to know about — honestly.
Cranio-cervical decompression is generally safe in experienced hands, but it is neurosurgery — with a specific set of complications that deserve straight talk.
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CSF leak
Cerebrospinal fluid can leak through the wound in the early days. Small leaks may settle; larger ones need re-suturing, a lumbar drain or revision.
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Meningitis
Bacterial meningitis is uncommon but serious. Fever, neck stiffness or new severe headache after surgery is investigated the same day.
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Aseptic meningitis
A sterile inflammatory reaction — usually after duraplasty — causing headache, fever and neck stiffness that settles with steroids.
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Hydrocephalus
A build-up of CSF within the brain in the weeks after surgery. Sometimes needs a temporary drain or a longer-term shunt.
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Pseudomeningocele
A collection of CSF under the skin at the wound. Many settle with time; some need aspiration, compression or revision surgery.
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Worsening syringomyelia
A syrinx that fails to shrink — or grows — after decompression may need a syringo-subarachnoid shunt or repeat surgery.
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Tonsillar herniation recurrence
Symptoms and radiological herniation can return, especially in bony-only cases. Interval MRI helps pick this up early.
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Cranial nerve injury
Lower cranial nerves sit close to the surgical field. Injury is uncommon but can cause swallowing or voice problems.
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Wound infection and vertebral artery injury
Superficial infection is usually managed with antibiotics. Vertebral artery injury is very rare but a recognised risk of C1 exposure.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever technique was used, the note the neurosurgeon sends you keeps to the same shape.
A quiet reminder
Neurosurgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication and technique chosen
Why the operation was done — Chiari I, syringomyelia, cervicomedullary compression — and which technique was agreed with you.
- 02 Technique
Craniectomy, laminectomy and dural work
Extent of bone removal, whether the dura was opened, the patch used, and whether tonsillar reduction was performed.
- 03 Findings
Intra-operative findings
Tonsillar position, adhesions, CSF flow observed at the foramen magnum, and any syrinx-related findings.
- 04 Impression
Recovery, red flags and follow-up MRI
Read this first: expected recovery, warning signs to act on, and when the follow-up MRI and clinical review are scheduled.
Recognised by major UK insurers
Cranio-cervical decompression for symptomatic Chiari I or syringomyelia is usually covered by major insurers when medically indicated. We confirm cover before booking.
Frequently asked
Everything we get asked about cranio-cervical decompression.
Quick answers on when surgery is needed, which technique fits which case, and what recovery looks like.
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What is cranio-cervical decompression?
A neurosurgical operation — sometimes called posterior fossa decompression — that removes a small amount of bone at the back of the skull and the top of the neck to relieve pressure at the cranio-cervical junction. It is used mainly for symptomatic Chiari I malformation and for syringomyelia.
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When is surgery actually needed?
When symptoms are disabling and clearly explained by the imaging: Valsalva-triggered occipital headache, cervicomedullary compression, a symptomatic syrinx, cerebellar or lower cranial nerve dysfunction, or progressive myelopathy. Incidental Chiari on imaging is not, in itself, a reason to operate.
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What imaging do I need before surgery?
An MRI of the brain and cervical spine, together with a CSF flow (cine MRI) study. These show tonsillar position, cord compression, any syrinx, and how CSF is moving at the foramen magnum.
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Bony-only decompression or with duraplasty — which is better?
Bony-only surgery is less invasive with lower morbidity but a lower success rate in clearly symptomatic cases. Duraplasty — opening the dura and enlarging it with a patch — gives more reliable decompression and is often preferred where symptoms are firmly established.
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What is tonsillar reduction and when is it added?
Shrinking or partially removing the cerebellar tonsils to reopen CSF flow. It is reserved for cases where the tonsils are markedly herniated, where scarring is expected, or where duraplasty alone is unlikely to suffice.
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How long is the hospital stay and recovery?
Typically 2–5 nights depending on the technique. Wound recovery takes 2–3 weeks; full return to activity 6–12 weeks. Headache patterns and neurological symptoms often improve over weeks to months.
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What are the main risks?
CSF leak, pseudomeningocele, aseptic meningitis, bacterial meningitis, hydrocephalus, wound infection, worsening or recurrent syringomyelia, cranial nerve injury and — very rarely — vertebral artery injury.
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Will surgery cure my syrinx?
A syrinx often shrinks after successful decompression, but not always. Persistent or growing syrinxes may need a syringo-subarachnoid shunt or repeat surgery. Interval MRI tracks the response.
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Which guidance underpins this treatment?
NICE guidance on Chiari malformation, the Society of British Neurological Surgeons, the American Association of Neurological Surgeons (AANS) and the European Association of Neurosurgical Societies (EANS) — all consulted when we build the plan with you.
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In practice, in London
Where cranio cervical decompression sits in a private London pathway
For cranio cervical decompression, the private London route is mostly about consultant fit and hospital choice rather than raw waiting time. On the NHS, cranio cervical decompression typically sits behind a triage step and a wait that can stretch from a few weeks into months. In London’s private sector, the same appointment often lands within days. That speed matters when symptoms are disrupting work, sleep, or a plan you’d already committed to — and it’s the single most common reason people call us in the first place.
A typical private booking for cranio cervical decompression in London starts with a consultant conversation — sometimes in person on Harley Street or Marylebone, sometimes on video if that suits better. Any imaging or diagnostics happen at a nearby CQC-registered facility, and reports usually land within 24 to 72 hours. The whole loop, from first call to written report, is often done inside a fortnight. For cranio cervical decompression in particular, we bias towards consultants who do this every week rather than every month.
Where a good concierge earns its keep is in the matching. There are dozens of consultants in London who see cranio cervical decompression — but not all of them are the right fit for every case. We narrow it down based on subspecialty, insurer coverage, the specific question being asked, and whether continuity into treatment matters. The right first appointment saves you from repeating yourself later.
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