The treatment of Chiari malformation type 1 (CM-I) with posterior fossa decompression without (PFD) or with duraplasty (PFDD) is controversial. Our aim is to compare the clinical outcome between the two methods for the treatment of CM-I. In this paper, the authors report a systematic review and meta-analysis of operation time, clinical improvement, and complications of PFD compared with PFDD for the treatment of CM-I. Randomized or non-randomized controlled trials of PFD and PFDD were considered for inclusion. Twelve published reports of eligible studies involving 841participants meet the inclusion criteria. There is significant difference in the operative time [mean difference =-74.63, 95 % CI (-83.02, -66.25), p < 0.05] in favor of PFD compared with PFDD. There is significant difference in overall complication rates [mean difference = 0.34, 95 % CI (0.19, 0.60), p < 0.05] and rates of CSF leak [mean difference = 0.24, 95 % CI (0.07, 0.78), p < 0.05] in favor of PFD groups. However, there is significant difference in the clinical improvement rate in favor of the PFDD group [mean difference = 0.85, 95 % CI (0.73, 0.99), p < 0.05]. Although PFDD is related with longer operation time and higher CSF leak rate, it can still be considered as a preferable treatment option for most CM-I patients for its higher improvement rate. More evidence from advanced multi-center studies are needed to provide illumination for the surgical decision making of CM-I.