SUMMARY: Professor Nimrod Mgwanb'ombe, challenges us with a complicated case of cranio-vertebral junction abnormalities presenting as an Chiari I problem symptomatically. However the pathology was complicated by the compaction of the brain stem through the foramen magnum and the posterior displacement of the dens impacting the brain stem and basilar invagination. See how this case management evolves and how it is a genetically related disorder with different anatomical lesions. It is only found in certain tribes in Africa. This is another fine scholarly presentation by Dr. Mgwamb'ombe. The patient failed three operations to decompress and stabilize the craniovertebral junction. Is this a developmental genetic disease effecting the brain, neurons, and bony structures. as Dr. Tom Milhorat suggested and Dr. Lazareff questioned being treated unsuccessfully surgically? How would you manage this case? 36 minutes (JIA)