Hello, Very sorry to hear your wife is in terrible pain. The disorder is no longer referred to as Arnold-Chiari malformation rather just Chiari malformation (along with various types, I, II, etc). The definitive treatment to this problem is in fact surgery and this should relieve the headaches and neck pain so long as the diagnosis is accurate. If you or she have any doubts on how well surgery will work then, I recommend you seek a 2nd opinion on the case before committing to the surgery. It is true that many get surgerized but do not experience significant relief. Unfortunately, even when the diagnosis is dead-on. Still, surgery does not seem to completely relieve symptoms because in some patients they also have other underlying problems such as HEADACHE DISORDER or cervical spine arthritides. A 2nd opinion may help identify other comorbid issues that could make it appear that surgery was unsuccessful since neurosurgeons and radiologists are not always in search of anything except strict measurements of the cerebellar tonsils. Was a CSF flow study accomplished? What are the details on the multiple cysts you mention? Hope I have answered your query. Let me know if I can assist you further. Take care Regards, Dr Dariush Saghafi, Neurologist