Headache characteristics and postoperative course in Chiari I malformation

Thunstedt, Dennis C.; Schmutzer, Michael; Fabritius, Matthias P.; Thorsteinsdottir, Jun; Kunz, Mathias; Ruscheweyh, Ruth; Straube, Andreas

doi:10.1177/03331024221079296

Cited by 13 publications

(7 citation statements)

References 31 publications

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“…Milhorat et al, in their study by observing 364 patients, stated that 86% of these patients had headache and most commonly localized pain in the occipital and nuchal region, exacerbated by valsalva-like maneuvers, and in the form of crushing and pressure ( 14 ). Similarly, Thunstedt et al reported that 63% of CM1 patients had headache, and 80% of this headache was localized in the occipital and nuchal regions ( 15 ). In our study, we found that there was a 61% headache and the localization was in a similar region.…”

Section: Discussionmentioning

confidence: 92%

The role of ONSD in the assessment of headache associated with Chiari malformation type 1

Karadağ

Akyüz²,

Şahin³

2023

Front. Neurol.

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BackgroundCough associated headache is the most common symptom in Chiari malformation type 1 (CM1). However, its pathophysiology and treatment are not clear. The aim of this study was to investigate the relationship between optic nerve sheath diameter (ONSD), an indicator of intracranial pressure, and headache and to investigate its predictive value on postoperative outcome.MethodsIn symptomatic CM1 patients, craniovertebral junction morphometric measurements and ONSD measurements were made from preoperative MR images, and headache intensities and characteristics were evaluated. After different surgical procedures, the clinical characteristics of the patients were evaluated according to the Chicago Chiari Outcome Scale, the change in headache intensity was assessed and the relationship with ONSD was evaluated.ResultsPreoperative headache intensity was significantly correlated with ONSD measurement (p < 0.01). Modified clivoaxial angle and ONSD were independent predictors of postoperative clinical outcome (p < 0.01). The procedure that achieved the greatest surgical enlargement of the foramen Magnum stenosis provided the best clinical outcome. Postoperative reduction in headache intensity and ONS diameter were correlated (p < 0.01).ConclusionThe fact that ONSD is found to be wide in the preoperative period in CM1 patients indicates that the intracranial pressure is permanently high. This diameter increase is correlated with headache and is a valuable guide in the selection of the appropriate treatment method.

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Section: Discussionmentioning

confidence: 92%

The role of ONSD in the assessment of headache associated with Chiari malformation type 1

Karadağ

Akyüz²,

Şahin³

2023

Front. Neurol.

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“…We found that approximately 8% of pediatric/adolescent (47) and 14.2% of adult (48) cases reported migraines, suggesting that the risk in CIM patients and patients with primary headache is comparable and atypical headache is often an incidental finding. Therefore, some scholars conclude that the presence of atypical headaches may be coincidental and mechanistically distinct from the specific symptoms of CIM (15,16). Consequently, conservative treatment is recommended (2,6,37).…”

Section: Surgery For Typical Headachementioning

confidence: 99%

“…Although relief of atypical headaches is achieved in many cases of CIMs after PFD, Thunstedt et al. (15) noted the effect was smaller than a typical headache, which cannot be ruled out as a result of the natural course of primary headache as well as the placebo effect of surgery. Notably, Thunstedt pointed out that the relationship between atypical headache and CIM remains unclear and requires further study.…”

Section: Surgery For Typical Headachementioning

confidence: 99%

“…The incidence of atypical headaches in CIMs has long been thought to be comparable to the general population and is usually incidental. Accordingly, they should be treated with conservative treatment alone (15,16). However, contrasting studies revealed an increased prevalence of atypical headaches in CIMs compared with the general population and significant improvement is experienced after PFD, suggesting that atypical headaches can be considered part of the pathological spectrum of symptoms of CIMs (9,17).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and treatment of typical and atypical headaches in patients with Chiari I malformation: A meta-analysis and literature review

Zhang

Huang

et al. 2023

Cephalalgia

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Objective A meta-analysis was conducted to analyze the incidence of typical and atypical headaches and outcomes following various treatments in patients with Chiari I malformation. Background Headache is the most common symptom of Chiari malformation, which can be divided into typical and atypical subgroups to facilitate management. Much controversy surrounds the etiology, prevalence and optimal therapeutic approach for both types of headaches. Method We identified relevant studies published before 30 July 2022, with an electronic search of numerous literature databases. The results of this study were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Result A total of 1913 Chiari malformation type I CIM patients were identified, 78% of whom presented with headache, within this group cephalgia was typical in 48% and atypical in 29% of patients, and migraine was the most common type of atypical headache. The ratio of typical/atypical headaches with international classification of headache disorders diagnosis was 1.53, and without international classification of headache disorders diagnosis was 1.56, respectively. The pooled improvement rates of typical headaches following conservative treatment, extradural decompression and intradural decompression were 69%, 88%, and 92%, respectively. The corresponding improvement rates for atypical headaches were 70%, 57.47%, and 69%, respectively. The complication rate in extradural decompression group was significantly lower than in intradural decompression group (RR, 0.31; 95% CI: 0.06–1.59, I2 = 50%, P = 0.14). Low reoperation rates were observed for refractory headaches in extradural decompression and intradural decompression groups (1%). Conclusion The International Classification of Headache Disorders can assist in screening atypical headaches. extradural decompression is preferred for typical headaches, while conservative therapy is optimal for atypical headaches. A definite correlation exists between atypical headaches and Chiari Malformation Type I patients with higher prevalence than in the general population. Importantly, decompression is effective in relieving headaches in this particular patient population.

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“…CM-I are primary signs of compression caused by herniated cerebellar tonsils or SM. 4 Congenital CM-I is usually treated surgically, although acquired CM-I can be treated etiologically. Surgical options for the treatment of CM-I include posterior fossa decompression (PFD), posterior fossa decompression with duraplasty (PFDD), and posterior fossa decompression with resection of tonsils (PFDRT).…”

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confidence: 99%

Prognostic analysis of posterior fossa decompression with or without cerebellar tonsillectomy for Chiari malformation type I: a multicenter retrospective study

Cai

Wang

Chai

et al. 2023

Neurosurgical Focus

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OBJECTIVE The purpose of this study was to compare the prognosis of patients with Chiari malformation type I (CM-I) treated with posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression with resection of tonsils (PFDRT). METHODS The clinical data of patients with CM-I treated using these two procedures in three medical centers between January 2016 and June 2021 were retrospectively analyzed and divided into PFDD and PFDRT groups according to the procedures. The Chicago Chiari Outcome Scale (CCOS) was used to score the patients and compare the prognosis of the two groups. RESULTS A total of 125 patients with CM-I were included, of whom 90 (72.0%) were in the PFDD group, and 35 (28.0%) were in the PFDRT group. There was no significant difference in the overall essential characteristics of the two groups. Moreover, there was no significant difference in complication rates (3.3% vs 8.6%, p = 0.348), CCOS scores (13.5 ± 1.59 vs 14.0 ± 1.21, p = 0.111), and the probability of poor prognosis (25.6% vs 11.4%, p = 0.096) between the two groups. Nevertheless, a subgroup of patients who had CM-I combined with syringomyelia (SM) revealed higher CCOS scores (13.91 ± 1.12 vs 12.70 ± 1.64, p = 0.002) and a lower probability of poor prognosis (13.0% vs 40.4%, p = 0.028) in the PFDRT than in the PFDD group. Also, SM relief was more significant in patients in the PFDRT compared to the PFDD group. A logistic multifactor regression analysis of poor prognosis in patients with CM-I and SM showed that the PFDRT surgical approach was a protective factor compared to PFDD. Furthermore, by CCOS analysis, it was found that the main advantage of PFDRT in treating patients with CM-I and SM was to improve patients’ nonpain and functionality scores. CONCLUSIONS Compared with PFDD, PFDRT is associated with a better prognosis for patients with CM-I and SM and is a protective factor for poor prognosis. Therefore, the authors suggest that PFDRT may be considered for patients with CM-I and SM.

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Headache characteristics and postoperative course in Chiari I malformation

Cited by 13 publications

References 31 publications

The role of ONSD in the assessment of headache associated with Chiari malformation type 1

The role of ONSD in the assessment of headache associated with Chiari malformation type 1

Prevalence and treatment of typical and atypical headaches in patients with Chiari I malformation: A meta-analysis and literature review

Prognostic analysis of posterior fossa decompression with or without cerebellar tonsillectomy for Chiari malformation type I: a multicenter retrospective study

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